Practices of Procedural Pain Management in Neonates through Continuous Quality Improvement Measures.

Jigar P Thacker,Deep S Shah,Somashekhar M Nimbalkar,Dipen V Patel,Samuel Menahem

doi:10.1155/2022/8605071

Jigar P Thacker, Deep S Shah + Show 3 more

Open Access

https://doi.org/10.1155/2022/8605071

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Abstract

Objective Although the benefits of pain control measures in neonates are well known, the actual usage was not optimal in our unit. Therefore, we implemented a quality improvement project to improve pain management practices through multiple Plan-Do-Study-Act (PDSA) cycles. Method Our project included hemodynamically stable newborns weighing ≥1300 g. We identified four common procedures: intravenous cannulation, venous sampling, heel prick, and nasogastric tube insertion. The selected pain control measures were skin-to-skin contact, breastfeeding, expressed breast milk orally, and oral sucrose. Between April 2019 and September 2019, we intervened multiple times and reassessed shortcomings. We encouraged evidence-based practices and gave solutions for shortcomings. Data were interpreted weekly to assess the compliance to pain control interventions. Results Minimal pain control measures (3-4%) were utilized for identified procedures before the project began. We could improve the use of pain control measures steadily and achieve the target of 80% of procedures after seven different interventions over five months. There was a retention of the effect on reassessing twice at second and fourth months of stopping further intervention once the target got achieved. Conclusion Quality Improvement science can identify the shortcomings and help to improve the compliance for pain control practices in neonates, as demonstrated in this neonatal unit.

Highlights

The neuroanatomical and neurobiochemical maturation of neonates to perceive painful and nociceptive stimuli were demonstrated by the mid-1980s [1, 2]
After reviewing the literature [12, 14] and assessing the local feasibility, we identified four feasible pain control interventions while performing identified invasive procedures: skin to skin contact or kangaroo mother care (KMC), direct breastfeeding, expressed breast milk (EBM) by mouth, and oral sucrose
The proportion of pain control measures utilized during the four invasive procedures was negligible at 3-4%

Summary

Introduction

The neuroanatomical and neurobiochemical maturation of neonates to perceive painful and nociceptive stimuli were demonstrated by the mid-1980s [1, 2]. Though measuring and quantifying painful experiences in neonates objectively is difficult, various standardized pain scales have been studied. Neonatal pain should be prevented whenever possible, and pain control interventions must be implemented when it is unavoidable. Many nonpharmacological and pharmacological pain control interventions have been adopted over time. The nonpharmacological measures are as follows: breastfeeding or expressed breast milk (EBM), skin to skin contact (SSC) or kangaroo mother care (KMC), swaddling, and nonnutritive sucking, among others. The pharmacological measures include oral sucrose (24% solution), local or topical anesthesia, and systemic drugs like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or general anesthetics [11,12,13].

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Conclusion