Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 25;16(11):e74410.
doi: 10.7759/cureus.74410. eCollection 2024 Nov.

Improving Procedural Pain Management for Newborns in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative

Sheetal Sriraman  1 , Pavani Chitamanni  1 , Raj Krishna Yadav  2 , Sukhvinder Ranu  2
Affiliations

Improving Procedural Pain Management for Newborns in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative

Sheetal Sriraman et al. Cureus. .

Abstract

Introduction: Neonatal pain has been associated with numerous adverse outcomes, making pain management essential in the neonatal intensive care unit (NICU). Our specific, measurable, actionable, realistic, and timely (SMART) aim was to increase the proportion of neonates receiving pain management interventions during painful procedures from a baseline of less than 30% to above 50% within six months.

Methods: The Plan-Do-Study-Act (PDSA) model for improvement methodology was employed to improve pain management in the NICU between August 2022 and July 2023. Interventions included educational campaigns, monthly meetings, weekly huddles, smart order sets, readily available medication information, and accessibility. Data was collected by reviewing the electronic health record (EHR), and survey data was collected through anonymous surveys of the NICU staff. The outcome measures were the proportion of sucrose and 4% lidocaine orders placed and the proportion of procedures that received pain management interventions.

Results: During the period from August 2022 to July 2023, there were 383 newborns admitted to the NICU. On average, each newborn underwent 42.8 procedures during their hospital stay. The proportion of neonates who were ordered sucrose and 4% lidocaine increased from a baseline of 7% and 21% to 43% and 54% after the second PDSA cycle, respectively. The proportion of procedures for which sucrose and lidocaine were administered increased from 16% and 21% at baseline to 54% and 65% after the second PDSA cycle.

Conclusion: The quality improvement (QI) methodology in conjunction with the education of NICU staff and the incorporation of smart order sets can be used to effectively increase the use of pain management interventions in the NICU.

Keywords: neonates; oral sucrose; pain; pdsa model; quality improvement.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board (IRB) at the State University of New York (SUNY) Downstate Medical Center issued approval 1952090-1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Key driver diagram used during the planning and implementation phases of the QI
QI: quality improvement
Figure 2
Figure 2. Fishbone diagram
Figure 3
Figure 3. Statistical process control chart representing the proportion of infants in the NICU who were ordered oral sucrose solution
A: educational campaign; B: monthly stakeholder meetings; C: weekly huddles; D: note-writing assistance; E: readily available medication information; F: incorporation of smart order sets; G: placement of sucrose and lidocaine in readily accessible locations NICU: neonatal intensive care unit; UCL; upper control limit; LCL: lower control limit
Figure 4
Figure 4. Statistical process control chart representing the proportion of infants in the NICU who were ordered 4% lidocaine
A: educational campaign; B: monthly stakeholder meetings; C: weekly huddles; D: note-writing assistance; E: readily available medication information; F: incorporation of smart order sets; G: placement of sucrose and lidocaine in readily accessible locations NICU: neonatal intensive care unit; UCL: upper control limit; LCL: lower control limit
Figure 5
Figure 5. Statistical process control chart representing the proportion of procedures that received sucrose for pain
A: educational campaign; B: monthly stakeholder meetings; C: weekly huddles; D: note-writing assistance; E: readily available medication information; F: incorporation of smart order sets; G: placement of sucrose and lidocaine in readily accessible locations UCL: upper control limit; LCL: lower control limit
Figure 6
Figure 6. Statistical process control chart representing the proportion of procedures that received lidocaine for pain management
A: educational campaign; B: monthly stakeholder meetings; C: weekly huddles; D: note-writing assistance; E: readily available medication information; F: incorporation of smart order sets; G: placement of sucrose and lidocaine in readily accessible locations UCL: upper control limit; LCL: lower control limit
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Neonatal pain: perceptions and current practice. Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Crit Care Nurs Clin North Am. 2018;30:549–561. - PMC - PubMed
    1. Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Cruz MD, Fernandes AM, Oliveira CR. Eur J Pain. 2016;20:489–498. - PubMed
    1. The neurobiology of pain: developmental aspects. Fitzgerald M, Beggs S. Neuroscientist. 2001;7:246–257. - PubMed
    1. Pathway to pain. Farley S. Nat Rev Neurosci. 2003;4:158.
    1. Treatment of pain and stress in the neonate: when and how. Khurana S, Whit Hall R, Anand KJ. Neoreviews. 2005;6:0–86.

LinkOut - more resources