Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates

Abstract

OBJECTIVE. Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process.METHODS. Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These centers developed and implemented evidence-based potentially better practices for pain management and sedation in neonates. The group introduced changes through plan-do-study-act cycles and tracked performance measures throughout the process.RESULTS. Strategies for implementing potentially better practices varied between centers on the basis of local characteristics. Individual centers identified barriers to implementation, developed tools for improvement, and shared their experience with the collaborative. Baseline data from the 12 sites revealed substantial opportunities for improved pain management, and local potentially better practice implementation resulted in measurable improvements in pain management at participating centers.CONCLUSIONS. The use of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices at participating centers.www.pediatrics.org/cgi

Sedation in the Neonatal Intensive Care Unit: International Practice

“…Based on these findings, an evidence-based protocol whereby ventilated newborn infants were suctioned only as needed based on clinical indicators was developed. This protocol was subsequently introduced as part of the collaborative quality improvement initiative earlier mentioned [41] and resulted in a significant decrease in the number of procedures performed. Four-handed care to facilitate containment during endotracheal suctioning was also associated with a decrease in stress and defense behavior and an increase in self-regulatory behavior [42].…”

Hospitalized Infants Who Hurt: A Sweet Solution With Oral Sucrose

“…Ninety-one percent of the centers that participated in a neonatal intensive care quality improvement collaborative of 12 NICUs chose Sweet-Ease (a prepackaged 11-mL container). 30 For the purpose of our article, sucrose for infant analgesia is referred to as oral sucrose.…”

“…Scrutiny of the literature on pain associated with immunization and use of oral sucrose at 2, 4, and 6 months of age has led experts to conclude that the analgesic effect of oral sucrose is diminished at 4 months. 30,38,39,43 The appropriate volume of oral sucrose has also been examined, and precise dosing based on age is not clearly defined. Two independent measurements indicated that the volume of a 24% solution of sucrose administered from a pacifier dipped once was no greater than 0.2 mL.…”

“…38 Sucrose volumes ranging from 0.5 to 2 mL have been effective for analgesia for neonates. 30,38,39,43,44 Interestingly, the analgesic effect is not determined by the volume but rather by the infant's detection of a The onset of action of oral sucrose is 10 seconds, peak action occurs at 2 minutes, and the effect persists approximately 5 to 10 minutes. 37 Because of the rapid onset of action, analgesia is not attributable to oral absorption and clearance from the circulation.…”

“…Table 7 is an outline of the components of a policy on use of oral sucrose. Dunbar and colleagues 30 described the administration of oral sucrose in combination with a pacifier because of the added analgesic effect of NNS. The oral sucrose was dropped precisely onto the tongue with an oral syringe and then the infant was given a pacifier, or the sugar was administered by dipping the pacifier in the sucrose solution.…”