Abstract
BackgroundDespite the recommended guidelines, the neonatal management of pain and discomfort often remains inadequate. The purpose of the present study was to determine whether adding a pain and discomfort module to a computerized physician order entry (CPOE) system would improve pain and discomfort evaluation in premature newborns under invasive ventilation.MethodsAll newborns <37 weeks gestational age (GA) and requiring invasive ventilation were included in a prospective study during two 6-month periods: before and after the inclusion of the pain and discomfort evaluation module. The main outcome measure was the percentage of patients having at least one assessment of pain and discomfort per day of invasive ventilation using the COMFORT scale.ResultsA total of 122 patients were included: 53 before and 69 after the incorporation of the module. The mean age was 30 (3) weeks GA. After the module was included, the percentage of patients who benefited from at least one pain and discomfort assessment per day increased from 64% to 88% (p < 0.01), and the mean number (SD) of scores recorded per day increased from 1 (1) to 3 (1) (p < 0.01). When the score was not within the established range, the nursing staff adapted analgesia/sedation doses more frequently after module inclusion (53% vs. 34%, p < 0.001). Despite higher mean doses of midazolam after module introduction [47 (45) vs. 31 (18) μg/kg/hr, p < 0.05], the durations of invasive ventilation and hospital stay, and the number of nosocomial infections, were not significantly modified.ConclusionsAdding a pain and discomfort tool to the CPOE system was a simple and effective way to improve the systematic evaluation of premature newborns who required ventilatory assistance.
Highlights
Despite the recommended guidelines, the neonatal management of pain and discomfort often remains inadequate
Local protocol for managing pain and discomfort Since 2002, our Neonatal Intensive Care Unit (NICU) staff has followed the protocol that we collectively developed for managing pain and discomfort; this protocol can be consulted in paper form in the NICU protocol binder
Population From September 2008 to August 2009, 349 newborns
Summary
The neonatal management of pain and discomfort often remains inadequate. We observed that only two thirds of the neonates under invasive ventilatory assistance had benefited from at least one formalized evaluation per day; that is, with the use of a checklist This situation prompted us to develop a software module to manage PAD, which was included in our daily-use computerized physician order entry (CPOE) system. We chose this tool for two reasons. We assumed that the module would encourage physicians to become more directly involved in pain management, because they would have to validate an algorithm daily to evaluate PAD and adapt analgesic/ sedative treatment, based on the unit protocol. We assumed that this tool would encourage the nurses to score the pain objectively, because by doing so they would be able to adjust the analgesic/sedative doses on the basis of their evaluation
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