Routine Use of Analgesia for Venipuncture in a Tertiary Level Neonatal Intensive Care Setting: A Quality Improvement Study

Abstract

Introduction: Neonatal exposure to pain can lead to altered pain perception in later years of life. Despite the availability of measures to alleviate pain, routine use is lacking. We decided to conduct a quality improvement (QI) study to increase the use of analgesia during venipuncture, a common procedure in neonatal intensive care units, from a baseline of 0% to 50% over 8 weeks.

Methods: Fishbone analysis was used to identify the potential barriers, which were targeted to bring improvement through Plan-Do-Study-Action (PDSA) cycles. In the first cycle, education and training of healthcare providers were conducted for 3 weeks, followed by the second cycle, wherein the mother's own milk was made available bedside for analgesia use. In the third cycle, a small amount of pasteurized donor human milk was kept separately for analgesia, and 25% dextrose was made available in the fourth cycle as a last resort. The 2nd-4th PDSA cycles were performed for a period of 2 weeks each.

Results: The use of analgesia improved to 26% from baseline after the first cycle and subsequently to 46%, 50%, and 53% after the second, third, and fourth cycles, respectively. During the sustenance phase, in the initial 2 months, there was a decrease in analgesia use, but with prompt interventions and timely remediation, it increased up to 60%, which was sustained for the subsequent 3 months.

Conclusion: Using the QI model, we were able to identify lacunae in current care and drive a culture change, leading to an increase in the use of analgesia during venipuncture.

Keywords: Infant; Newborn; Pain; Pain management.

Fig. 1.

Fishbone analysis to identify barriers leading to lack of adequate analgesia during venipuncture.

Fig. 2.

Run chart of the PDSA cycles for improving analgesia use during venipuncture.

Fig. 3.

Distribution of the type of analgesia used during venipuncture.