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. 2022 Feb 25;4(2):69-77.
doi: 10.1002/pne2.12075. eCollection 2022 Jun.

Improving pain management in a neonatal intensive care unit with single-family room-A quality improvement project

Lene Tandle Lyngstad  1 , Solfrid Steinnes  1 , Flore Le Marechal  1
Affiliations

Improving pain management in a neonatal intensive care unit with single-family room-A quality improvement project

Lene Tandle Lyngstad et al. Paediatr Neonatal Pain. .

Abstract

Preterm birth is a risk factor for early experience of pain. Despite advances in neonatal care, evidence-based knowledge of the importance of adequate pain management and strong international guidelines for assessment and treatment of neonatal pain, only 10% of sick term and preterm infants were assessed for pain and stress on a daily basis. The aim of this quality improvement (QI) project is evaluation of implemented guidelines for pain assessment and management, and increased parental involvement in a Norwegian single-family room NICU. Method: The different steps of the project entailed translation of the English version of COMFORTneo, development and implementation of guidelines with flowcharts for pain management, and pain assessment certification of the interprofessional staff. Part two of the project is supervision of the interprofessional staff in parental involvement in stress- and painful procedures. Our study showed that one year after implementation, 88.8% of the COMFORTneo assessments were performed according to the pain management guidelines. The staff used the flowcharts to assess, treat and reassess pain and stress. There was a high interrater reliability with linearly weighted Cohen's kappa values ranging from 0.81 to 0.95, with a median of 0.90. In addition, our study showed increased parental involvement in procedures, from 50.3% before to 82.3% after the quality improvement project. The success of this quality improvement project is explained by systematic use of flowcharts and implemented guidelines for pain management, interprofessional collaboration, and cultural change agents. Theoretical lectures and practical bedside supervision to interprofessional staff increased parental involvement in stress- and painful procedures.

Keywords: pain management; preterm infant; quality improvement; single‐family room.

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Figures

FIGURE 1
FIGURE 1
Results study 2 (compliance to pain management guidelines). †75.0% of the scores were 14 and 90.0% of the scores were associated with low NRS pain or low NRS stress
See this image and copyright information in PMC

References

    1. Beck S, Wojdyla D, Say L, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88:31‐38. - PMC - PubMed
    1. Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain. 2015;31(4):355‐362. - PubMed
    1. Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Eur J Pain. 2016;20(4):489‐498. - PubMed
    1. Anand K. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155(2):173‐180. - PubMed
    1. Abdulkader HM, Freer Y, Garry EM, Fleetwood‐Walker SM, McIntosh N. Prematurity and neonatal noxious events exert lasting effects on infant pain behaviour. Early Hum Dev. 2008;84(6):351‐355. - PubMed