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Utilizing Quality Improvement Methodology to Implement a Perioperative Intravenous Acetaminophen Protocol in Neonatal
Joint Commission Journal on Quality and Patient Safety
|July 31, 2026
Summary
Implementing intravenous acetaminophen in neonates undergoing surgery effectively manages pain, aligning with Enhanced Recovery After Surgery guidelines. This approach reduces opioid exposure and ensures adequate analgesia for pediatric patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Pharmacology
Background:
- Enhanced Recovery After Surgery (ERAS®) guidelines emphasize multimodal analgesia to minimize opioid use in pediatric patients.
- Intravenous (IV) acetaminophen presents an alternative opioid-sparing analgesic option for neonatal surgical patients when oral or rectal routes are not feasible.
- Quality improvement methodologies were employed to introduce a perioperative IV acetaminophen protocol for neonates undergoing gastrointestinal surgery.
Purpose of the Study:
- To implement and evaluate a perioperative intravenous acetaminophen protocol for neonatal surgical patients.
- To assess protocol compliance and postoperative pain management.
- To provide a model for the integration of IV acetaminophen in neonatal surgical care.
Main Methods:
- A multidisciplinary team developed and implemented a standardized perioperative IV acetaminophen dosing protocol using a Plan-Do-Study-Act (PDSA) methodology.
- A second PDSA cycle introduced an online order set to enhance administration ease and compliance.
- Protocol compliance and postoperative pain (Neonatal Pain, Agitation, and Sedation Scale - NPASS) were the primary measures.
Main Results:
- The study included 50 prospective cases with an overall protocol compliance rate of 43.9%.
- Postoperative compliance (90.2%) significantly exceeded preoperative compliance (46.0%), with higher compliance observed when the online order set was utilized.
- Median NPASS scores at 24 and 48 hours (2.4 and 2.3, respectively) indicated adequate postoperative analgesia.
Conclusions:
- Perioperative IV acetaminophen can be successfully implemented as an analgesic in neonates undergoing gastrointestinal surgery.
- Sustained compliance requires ongoing education and continuous quality improvement efforts.
- This project offers a replicable model for enhancing pain management in this vulnerable patient population.
