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Evidenced-based clinical practice guideline for management of newborn pain
Kaye Spence1, David Henderson-Smart, Karen New
1Centre for Perinatal Health Services Research, University of Sydney, Sydney, New South Wales, Australia. kaye@chw.edu.au
Insights
A new clinical practice guideline was developed to improve newborn pain management and close the evidence-practice gap. This guideline supports clinicians in neonatal intensive care and special care units.
Area of Science:
- Neonatal care
- Evidence-based practice
- Clinical guideline development
Background:
- Significant evidence-practice gap exists in newborn pain management.
- Variability in current clinical practice guidelines for newborn pain across Australian hospitals.
Purpose of the Study:
- To develop a clinical practice guideline for newborn pain management.
- To facilitate evidence uptake and reduce the evidence-practice gap.
Main Methods:
- Audit of practice and appraisal of existing guidelines in 23 Australian hospitals.
- Appraisal of guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.
- Literature search to identify best evidence for newborn pain management.
Main Results:
- Seventeen hospitals had existing clinical practice guidelines, but consistency was lacking.
- A best practice guideline was developed based on current evidence and expert recommendations.
- An audit tool and algorithms for pain assessment and procedural pain were included.
Conclusions:
- The developed guideline is applicable in neonatal intensive care and special care units.
- It can support existing practices or encourage clinicians to address the evidence-practice gap.
- Aims to standardize and improve the management of pain in newborns.
Aim:
To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.
Method:
An audit of practice and an appraisal of clinical practice guidelines were undertaken to establish current practices and guideline availability for the management of newborn pain in 23 hospitals in Australia. Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation instrument. A literature search was undertaken to acquire the evidence for best practice for management of newborn pain.
Results:
Neonatal units in 17 hospitals had clinical practice guidelines. Each was peer reviewed and assessed according to the domains of the Appraisal of Guidelines for Research and Evaluation instrument. There was lack of consistency across the guidelines. As a result, a best practice guideline was developed based on current best evidence and the Royal Australian College of Physicians recommendations. To facilitate an ongoing compliance with the guideline, an audit tool was included together with algorithms for procedural pain and pain assessment.
Conclusion:
The clinical practice guideline can be used by clinicians in varying settings such as the neonatal intensive care and special care unit. The document can be used to support existing practices or challenge clinicians to close the evidence practice gap for the management of newborn pain.
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