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Practices of Procedural Pain Management in Neonates through Continuous Quality Improvement Measures
Jigar P Thacker1, Deep S Shah1, Dipen V Patel2
1Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Dist. Anand, Gujarat, India.
Insights
Implementing quality improvement strategies significantly enhanced neonatal pain management, increasing the use of pain control measures from 3-4% to 80% for common procedures. This improvement was sustained after interventions ceased.
Area of Science:
- Neonatal care
- Quality improvement science
- Pain management
Background:
- Optimal pain control in neonates is crucial but often underutilized.
- A quality improvement project was initiated to address suboptimal pain management practices.
Purpose of the Study:
- To enhance pain management practices in a neonatal unit.
- To increase the utilization of evidence-based pain control measures.
Main Methods:
- The project focused on hemodynamically stable newborns weighing ≥1300g.
- Four common procedures were targeted: IV cannulation, venous sampling, heel prick, and NG tube insertion.
- Interventions included skin-to-skin contact, breastfeeding, expressed breast milk, and oral sucrose, with data assessed weekly over five months.
Main Results:
- Initial use of pain control measures was low (3-4%).
- After seven interventions, compliance reached the target of 80% for identified procedures.
- The achieved improvement was sustained, as confirmed by follow-up assessments.
Conclusions:
- Quality Improvement science provides a framework to identify and rectify deficits in neonatal pain management.
- The project successfully improved compliance with evidence-based pain control practices in the neonatal unit.
Objective:
Although the benefits of pain control measures in neonates are well known, the actual usage was not optimal in our unit. Therefore, we implemented a quality improvement project to improve pain management practices through multiple Plan-Do-Study-Act (PDSA) cycles.
Method:
Our project included hemodynamically stable newborns weighing ≥1300 g. We identified four common procedures: intravenous cannulation, venous sampling, heel prick, and nasogastric tube insertion. The selected pain control measures were skin-to-skin contact, breastfeeding, expressed breast milk orally, and oral sucrose. Between April 2019 and September 2019, we intervened multiple times and reassessed shortcomings. We encouraged evidence-based practices and gave solutions for shortcomings. Data were interpreted weekly to assess the compliance to pain control interventions.
Results:
Minimal pain control measures (3-4%) were utilized for identified procedures before the project began. We could improve the use of pain control measures steadily and achieve the target of 80% of procedures after seven different interventions over five months. There was a retention of the effect on reassessing twice at second and fourth months of stopping further intervention once the target got achieved.
Conclusion:
Quality Improvement science can identify the shortcomings and help to improve the compliance for pain control practices in neonates, as demonstrated in this neonatal unit.
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