Procedural Analgesia in the Neonatal Intensive Care Unit: A Quality Improvement Initiative

Abstract

Objective Neonates perceive pain which also has adverse long-term consequences. Newborns experience several painful procedures a day. Various methods of analgesia may be used but are underutilized. The SMART aim of this project was to increase the use of procedural analgesia from 11.5 to 75% in 6 months by using quality improvement principles.

Study Design After a baseline audit, a root cause analysis was done. Based on this, a series of interventions were done as Plan-Do-Study-Act (PDSA) cycles. These included posters on analgesia, display of the pain protocol, orders for analgesia, a written test, small power point presentations on the importance of analgesia, and reminders on the trays used for procedures. At the end of each PDSA cycle, an audit was done to determine the proportion of times analgesia was used. Process indicators were also used when possible. Analysis was done by using the Chi-square test and the paired t-test.

Results At baseline 11% of procedures were done after giving analgesia. This significantly improved to 40% at the end of the first PDSA, and 81% after third PDSA. This was sustained at 75% over the next 2 months.

Conclusion Procedural analgesia can improve and be sustained by using simple interventions.

Key Points

• Procedural pain in neonates can be decreased by the use of analgesia.

• However, most units do not utilize analgesia appropriately.

• This QI showed that simple interventions can optimize use of procedural analgesia.

Keywords

procedures - analgesia - neonate - pain

Authors' Contributions

S.R. helped design the interventions, drew the Ishikawa diagram, and helped in writing the manuscript. S.N. conceptualized the project and wrote the manuscript. J.J., I.B., and S.S. designed and implemented the interventions and did the audits.

Publikationsverlauf

Eingereicht: 30. November 2020

Angenommen: 03. Februar 2021

Artikel online veröffentlicht:
11. März 2021

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