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Procedural Analgesia in the Neonatal Intensive Care Unit: A Quality Improvement Initiative
Sushma Reddy1, Saudamini V Nesargi1, Sofia Stevens1
1Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India.
Insights
Neonatal procedural analgesia use significantly increased from 11% to 81% and was sustained at 75% using quality improvement interventions. This demonstrates that simple strategies can effectively manage infant pain during medical procedures.
Area of Science:
- Neonatal care
- Pediatric pain management
- Quality improvement in healthcare
Background:
- Neonates experience significant procedural pain, leading to adverse long-term effects.
- Underutilization of analgesia is common despite available methods for managing neonatal pain.
- Effective pain management in newborns is crucial for their immediate and future well-being.
Purpose of the Study:
- To significantly increase the utilization of procedural analgesia in neonates.
- To achieve a SMART (Specific, Measurable, Achievable, Relevant, Time-bound) aim of increasing analgesia use from 11.5% to 75% within 6 months.
- To implement and evaluate quality improvement principles for optimizing pain management in newborns.
Main Methods:
- A baseline audit was conducted, followed by a root cause analysis to identify barriers to analgesia use.
- Plan-Do-Study-Act (PDSA) cycles were implemented, incorporating interventions like educational materials, protocol displays, and procedural reminders.
- Data on analgesia use were collected through audits at the end of each PDSA cycle, with statistical analysis using Chi-square and paired t-tests.
Main Results:
- Procedural analgesia use increased from a baseline of 11% to 40% after the first PDSA cycle.
- Further improvement was observed, reaching 81% after the third PDSA cycle.
- The improved rate of analgesia use was sustained at 75% over a subsequent 2-month period.
Conclusions:
- Simple, targeted interventions can effectively improve and sustain the use of procedural analgesia in neonates.
- Quality improvement initiatives are a viable strategy for optimizing pain management in neonatal care.
- Addressing underutilization of analgesia is achievable through systematic quality improvement efforts.
Objective:
Neonates perceive pain which also has adverse long-term consequences. Newborns experience several painful procedures a day. Various methods of analgesia may be used but are underutilized. The SMART aim of this project was to increase the use of procedural analgesia from 11.5 to 75% in 6 months by using quality improvement principles.
Study Design:
After a baseline audit, a root cause analysis was done. Based on this, a series of interventions were done as Plan-Do-Study-Act (PDSA) cycles. These included posters on analgesia, display of the pain protocol, orders for analgesia, a written test, small power point presentations on the importance of analgesia, and reminders on the trays used for procedures. At the end of each PDSA cycle, an audit was done to determine the proportion of times analgesia was used. Process indicators were also used when possible. Analysis was done by using the Chi-square test and the paired t-test.
Results:
At baseline 11% of procedures were done after giving analgesia. This significantly improved to 40% at the end of the first PDSA, and 81% after third PDSA. This was sustained at 75% over the next 2 months.
Conclusion:
Procedural analgesia can improve and be sustained by using simple interventions.
Key Points:
· Procedural pain in neonates can be decreased by the use of analgesia.. · However, most units do not utilize analgesia appropriately.. · This QI showed that simple interventions can optimize use of procedural analgesia..
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