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The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type
Bonnie Stevens1,2, Mariana Bueno3, Melanie Barwick1,4
1The Hospital for Sick Children, Research Institute, Child Health and Evaluative Sciences, Toronto, ON, Canada.
Insights
The Implementation of infant pain practice change (ImPaC) intervention effectively reduced painful procedures and improved pain assessment and treatment in neonatal intensive care units. This web-based resource demonstrated significant benefits for infant pain management.
Area of Science:
- Neonatal intensive care
- Pain management
- Healthcare interventions
Background:
- Infant pain in neonatal intensive care units (NICUs) requires effective management strategies.
- Current pain practices in NICUs may not consistently incorporate evidence-based approaches.
- A need exists for accessible resources to facilitate practice change in infant pain management.
Purpose of the Study:
- To evaluate the intervention effectiveness of the Implementation of infant pain practice change (ImPaC) web-based resource.
- To assess the implementation effectiveness and feasibility of ImPaC in Canadian NICUs.
- To determine the impact of ImPaC on the number of painful procedures, pain assessment, and pain intensity in infants.
Main Methods:
- A hybrid type 1 effectiveness-implementation study design was employed.
- Twenty-three Canadian NICUs were cluster randomized into an intervention (ImPaC) group or a usual care (waitlist) group.
- Intention-to-treat and wait-list analyses assessed painful procedures, pain assessment, and pain intensity over a 6-month period.
Main Results:
- The intervention group showed a significantly lower average number of painful procedures per infant per day compared to the usual care group.
- Pain assessment was significantly greater, and pain intensity scores were significantly lower in the intervention group.
- Both intention-to-treat and wait-list analyses indicated improved pain management outcomes with the ImPaC intervention.
Conclusions:
- The ImPaC intervention is effective in reducing painful procedures and improving pain management in NICU infants.
- Implementation feasibility and fidelity of the ImPaC resource were associated with improved clinical outcomes.
- Web-based resources like ImPaC can successfully support practice change for infant pain management in NICUs.
Abstract:
Implementation of infant pain practice change (ImPaC) is a multifaceted web-based resource to support pain practice change in neonatal intensive care unit (NICU). We evaluated the (1) intervention effectiveness and (2) implementation effectiveness of ImPaC using a hybrid type 1 effectiveness-implementation study (ie, cluster randomized controlled trial and longitudinal descriptive study). Eligible level 2 and 3 Canadian NICUs were randomized to intervention (INT) or waitlisted to usual care (UC) for 6 months. We assessed the number of painful procedures, proportion of procedures accompanied by valid assessment and evidence-based treatment, and pain intensity to determine intervention effectiveness using intention-to-treat (ITT) and wait-list (WL) analyses. Implementation feasibility and fidelity were explored. Twenty-three NICUs participated (12 INT, 11 UC). Thirty infants/NICU were included in the ITT (INT = 354, UC = 325) and the WL (INT = 678, UC = 325) analyses. In the ITT analysis, the average number of painful procedures/infant/day was lower in the INT group [2.62 (±3.47) vs 3.85 (±4.13), P < 0.001] than in the UC group. Pain assessment was greater in the INT group (34.7% vs 25.5%, P < 0.001) and pain intensity scores were lower [1.47 (1.25) vs 1.86 (1.97); P = 0.029]. Similarly, in the WL analysis, there were fewer painful procedures/infant/day [3.11 (±3.98) vs 3.85 (±4.13), P = 0.003] and increased pain assessment (30.4% vs 25.5%, P = 0.0001) and treatment (31.2% vs 24.0%, P < 0.001) in the INT group. Feasibility and implementation fidelity were associated with improved clinical outcomes.
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