Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late...

Area of Science:

• Neonatal Medicine
• Pediatric Nutrition
• Quality Improvement Science

Background:

• Late preterm births represent a substantial proportion of all preterm deliveries.
• Optimal nutritional strategies and enteral feeding methods for late preterm infants are not well-established, often leading to reliance on intravenous (IV) fluids.
• Current practices may involve unnecessary IV access and starter parenteral nutrition (PN).

Purpose of the Study:

• To create and implement a feeding protocol for late preterm infants.
• The primary goals were to reduce the requirement for IV access, minimize the use of starter PN, and alleviate pain in neonatal intensive care unit (NICU) infants.
• To enhance the care and outcomes for late preterm infants.

Main Methods:

• The Plan-Do-Study-Act (PDSA) quality improvement model served as the framework.
• A comprehensive literature review informed the development of a feeding protocol emphasizing judicious starter PN use.
• The protocol was implemented, evaluated, and refined, including the addition of electronic medical record auto-text reminders.

Main Results:

• The protocol implementation led to a significant reduction in peripheral IV access, decreasing from 70% to 42% (P = .0017).
• There was a substantial decrease in the initiation of starter PN, from 55% to 7% (P < .00001).
• These reductions were achieved without significant adverse effects on other clinical measures, and infant pain was lessened.

Conclusions:

• Initiating enteral feedings upon admission for stable, late preterm infants is an effective strategy.
• This approach successfully reduces the need for peripheral IV access.
• Consequently, the implementation of this protocol decreases procedural pain for infants.