A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

Abstract

Background:Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan.Purpose:To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs).Methods:Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months).Findings:Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions.Implications for Practice:The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs.Implications for Research:Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting.

Practices of Procedural Pain Management in Neonates through Continuous Quality Improvement Measures

“…Two multicentric trials applied QI principles to improve neonatal pain management in the involved sites [ 23 , 24 ]. In both the studies, local groups were created, better practices were identified and implemented, and improvement over time at different involved sites was assessed but did not discuss site-specific processes or obstacles faced to implement the practices, as the current study does.…”

“…Quality improvement (QI) principles have improved neonatal pain management practices [ 23 , 24 ]. In addition, the World Health Organization's (WHO) 2007 Framework for Action for strengthening health systems in developing countries identified quality as one of the key drivers for improved health outcomes and greater efficiency in health service delivery [ 25 ].…”

Reducing Opioid Exposure in a Level IV Neonatal Intensive Care Unit

“… 24 A collaboration of 7 NICUs in Japan improved neonatal pain management through staff education, the use of objective pain scales within the electronic health record, and the implementation of best practice prescribing guidance. 25 Clinicians need to assess analgesia use after practice changes as increased opioid prescribing has also been observed following the implementation of neonatal pain and sedation protocols. 21 …”

Non-pharmaceutical intervention and pain management situation for neonatal analgesia

“…This may give us some implications for our pain management practice. 49 Most of the time, clinical workers may neglect neonates' parents, who worry deeply about their babies especially when undergoing painful procedures and so one program in Canada named Baby-Friendly Initiative was implemented. They made a five-minute videotranslated in Chinese language-played on websites, in which it is shown that babies undergoing blood collections while they were on breastfeeding, held skinto-skin and feeding sucrose by mouth.…”