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Pain Management in Neonatal Intensive Care: Evaluation of the Compliance With Guidelines
Daphne I Aukes1, Daniëlla W E Roofthooft1, Sinno H P Simons1
1Department of Pediatrics, Division of Neonatology.
Insights
Neonatal pain management protocol compliance was evaluated, finding most patients comfortable but with room for improvement in reassessments after treatment adjustments. Documentation of acceptable protocol violations is key.
Area of Science:
- Neonatal intensive care
- Pain management
- Clinical protocol compliance
Background:
- A neonatal intensive care unit implemented a pain management protocol in 2005.
- The protocol included individualized pain assessments and treatment guidelines using a decision tree.
Purpose of the Study:
- To prospectively assess medical and nursing staff adherence to the established pain management protocol.
Main Methods:
- Pain scores (COMFORTneo) and analgesic/sedative prescriptions were collected for 2011.
- Primary outcome: protocol compliance for pain assessment and treatment.
- Secondary outcome: reasons for noncompliance.
Main Results:
- 90% of 732 patients received fewer than 3 daily pain assessments.
- 86% of assessments indicated comfortable patients (COMFORTneo score 9-14).
- Reassessment within 60 minutes occurred in 31% of high pain score cases (≥14); treatment adjusted in 40%.
Conclusions:
- While most patients appeared comfortable, reassessment protocols post-treatment adjustment need improvement.
- Acceptable protocol deviations, like oversedation in palliative care, require thorough documentation.
Background:
A pain management protocol was implemented in our neonatal intensive care unit in 2005, including individual pain assessments and pain treatment guidelines with a decision tree.
Objectives:
To prospectively evaluate the degree of compliance of medical and nursing staff with the pain protocol.
Methods:
Prospectively recorded pain scores (COMFORTneo score) and all prescribed analgesics and sedatives for the calendar year 2011 were retrieved. The primary outcome was the degree of compliance to the protocol with respect to pain assessments and treatment; the secondary outcome consisted of reasons for noncompliance.
Results:
Of the 732 included patients, 660 (90%) received fewer than the stipulated 3 assessments per day. Eighty-six per cent of all assessments yielded a score between 9 and 14, suggesting a comfortable patient. In cases of high pain scores (≥14), reassessment within 60 minutes took place in 31% of cases and in 40% treatment was started or adjusted. In cases of low pain scores (≤8) during treatment, 13% of the 457 assessments were reassessed within 120 minutes and in 17% a dose reduction was performed.
Conclusions:
Although the majority of pain assessments suggested comfortable patients, there is room for improvement with respect to reassessments after adjustment of analgesic/sedative treatment. Some protocol violations such as oversedation in palliative patients are acceptable but should be well documented.
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