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Quality Improvement Intervention Decreases Pain and Adverse Events Due to Heel Lances in Infants
Betty Noergaard1, Helle Brems Olesen1, Ulla List Toennesen2
1Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
Insights
Implementing simple, cost-free interventions significantly improved infant comfort during heel lancing. This quality improvement initiative reduced pain and distress scores, though adverse events saw a non-significant decrease.
Area of Science:
- Neonatal care
- Pediatric pain management
- Quality improvement in healthcare
Background:
- Limited research exists on preventing adverse events during infant heel lancing.
- Previous studies focused on reducing pain, but not necessarily on adverse outcomes like edema or incision errors.
- This study addresses the gap by investigating interventions to improve infant comfort and reduce adverse events during heel lancing.
Purpose of the Study:
- To evaluate the impact of a multi-component quality improvement intervention on infant pain and distress during heel lancing.
- To assess the intervention's effect on reducing adverse events associated with heel lancing procedures.
- To determine if cost-free procedural changes can enhance infant well-being during heel lance procedures.
Main Methods:
- A pre- and post-intervention quality improvement study involving 189 and 186 heel lances in infants (postmenstrual age 28+0 to 43+6 weeks).
- Intervention components included skin-to-skin contact, comforting, sucrose/breastfeeding, warming cold heels, and staff ergonomics.
- Infant pain and discomfort were assessed using ComfortNeo, distress, and pain scores; adverse events were visually inspected.
Main Results:
- A significant increase in normal pain and distress scores was observed post-intervention during and after heel lancing (p < 0.05).
- Specifically, normal pain scores increased from 86% to 95% during and 95% to 99% after the intervention.
- Normal distress scores rose from 82% to 93% during and 90% to 99% after the intervention, with a non-significant reduction in adverse events (41 to 30).
Conclusions:
- Cost-free procedural modifications effectively decrease pain, discomfort, and adverse events in infants undergoing heel lancing.
- Continuous evaluation and optimization of painful procedures are recommended.
- Collaboration between healthcare staff and parents is crucial for managing infant pain and adverse events effectively.
Background:
Studies have investigated ways to reduce infants' pain during heel lancing, but research on preventing adverse events is scarce. This study investigated whether or not the number of infants with normal comfort (>8 and ≤14), distress (≤4), and pain (≤4) scores increased and whether or not the number of adverse events (blue and/or edematous heels and improperly placed incisions) decreased during and after heel lancing following an intervention.
Methods:
A pre- and post-quality improvement intervention including 189 and 186 heel lances, respectively, in infants (postmenstrual age ≥ 28 + 0 to ≤ 43 + 6 weeks) was conducted in May to July 2020 and April to July 2022. The intervention comprised five initiatives: skin-to-skin contact, comforting, sucrose/breastfeeding, warming cold heels, and ergonomics for staff. ComfortNeo score, along with distress and pain scores assessed the infants' pain and discomfort before, during, and after heel lancing. Adverse events were assessed visually.
Results:
Post-intervention, there was a significant increase in the number of infants with normal pain and distress scores during (86% to 95%, p = 0.01, and 82% to 93%, p = 0.01, respectively) and after (95% to 99%, p = 0.04, and 90% to 99%, p < 0.01, respectively) heel lancing compared to the pre-intervention. A non-significant reduction in the number of adverse events was observed (41 to 30, p = 0.17).
Conclusions:
Cost-free procedural changes can decrease pain, discomfort, and adverse events in infants undergoing heel lancing. Painful procedures should be evaluated and optimized. Staff and parents should collaborate to manage pain and adverse events.
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