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Neonatal pain assessment in Sweden - a fifteen-year follow up
1Department of Paediatrics, Örebro University Hospital, Sweden. maria.gradin@orebroll.se
Insights
Neonatal units increasingly use systematic pain assessment tools, with structured methods rising significantly since 1993. Further research is needed to link guideline implementation with actual pain assessment practices.
Area of Science:
- Neonatal care
- Pain management
- Clinical practice guidelines
Background:
- Systematic pain assessment is recommended by international and national guidelines to improve pain treatment and prevention in neonates.
- National surveys indicate significant variability in adherence to these guidelines.
Purpose of the Study:
- To evaluate the trends in the use of pain assessment tools in Swedish neonatal units over time.
- To assess the adoption of structured pain assessment methods.
Main Methods:
- A repeated cross-sectional survey of all Swedish neonatal units conducted in 1993, 1998, 2003, and 2008.
- Data collected focused on the utilization and perceived need for pain assessment tools.
Main Results:
- The percentage of neonatal units attempting pain assessment rose from 64% in 1993 to 83% in 2008.
- The use of structured pain assessment methods increased notably, from 3% in 1998 to 44% in 2003.
- Facial actions were the most frequently reported pain indicator.
Conclusions:
- A significant increase in the reported use of structured pain assessment tools was observed in neonatal units between 1993 and 2008.
- There is an identified need for more robust evidence on the correlation between the implementation of pain management guidelines and the consistent performance of pain assessments.
Background:
It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines.
Methods:
A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools.
Results:
The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions.
Conclusion:
The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.
