Implementing an Evidence-Based Neonatal Circumcision Pain Management Protocol: A Quality Improvement Initiative

Area of Science:

• Neonatal care
• Pain management
• Quality improvement

Background:

• Lack of standardized neonatal circumcision pain management guidelines causes inconsistent care and adverse outcomes.
• These issues can escalate healthcare costs, prolong hospital stays, and necessitate increased patient monitoring.
• Nurse practitioners (NPs) are ideally positioned to lead evidence-based quality improvement (QI) initiatives in this area.

Purpose of the Study:

• To evaluate an evidence-based neonatal circumcision pain protocol throughout the entire care process, from pre-procedure to recovery.
• Assessing the protocol's impact on neonatal pain scores and its long-term sustainability.

Main Methods:

• Utilized the Knowledge-to-Action framework and QI methodologies to guide the implementation and evaluation.
• The protocol included pre-circumcision acetaminophen, white noise during the procedure, standardized pain assessment, and post-procedure pain management with acetaminophen or nonpharmacologic methods.
• Provider compliance was crucial for the protocol's success.

Main Results:

• Neonatal pain scores significantly decreased from 3.14 to 1.12 (p <.001) post-implementation.
• Process objectives were met by the third Plan-Do-Study-Act cycle and sustained over time.
• One hundred percent of healthcare providers reported that the new protocol enhanced neonatal pain management.

Conclusions:

• A comprehensive strategy is essential for effective neonatal circumcision pain management.
• This QI initiative underscores the critical role of nurse practitioner leadership in implementing evidence-based changes.
• The protocol demonstrated significant improvements in pain reduction and provider agreement.