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Improving Postoperative Pain Management in the NICU Through Collaboration

Multidisciplinary teams at the nation’s children’s hospitals improved pain control in infants by standardizing pain management and workflow, researchers report.

At NICUs within the Children’s Hospitals Neonatal Consortium that care for infants with complex surgical problems, multidisciplinary teams were formed to develop aims, interventions, and measurement strategies to test in multiple Plan-Do-Study-Act cycles. Evidence-based interventions from the Clinical Practice Recommendations were adopted, including those on pain assessment tools, pain score documentation, nonpharmacologic treatment measures, pain management guidelines, communication of a pain treatment plan, routine discussion of pain scores during team rounds, and parental involvement in pain management.

Based on data from a minimum of 10 surgeries per month in Jan. to July 2019 (baseline), Aug. 2019 to June 2020 (improvement work period), and July to Dec. 2021 (sustain period), the investigators found: “The percentage of patients with unrelieved pain in the 24-hour postoperative period decreased by 35% from 19.5% to 12.6%. Family satisfaction with pain management measured on a 3-point Likert scale with positive responses ≥2 increased from 93% to 96%. Compliance with appropriate pain assessment and numeric documentation of postoperative pain scores according to local NICU policy increased from 53% to 66%. The balancing measure of the percentage of patients with any consecutive sedation scores showed a decrease from 20.8% at baseline to 13.3%. All improvements were maintained during the sustain period.”

Source: Pediatrics