Successful implementation of a neonatal pain and sedation protocol at 2 NICUs
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Successful implementation of a neonatal pain and sedation protocol at 2 NICUs. / Deindl, Philipp; Unterasinger, Lukas; Kappler, Gregor; Werther, Tobias; Czaba, Christine; Giordano, Vito; Frantal, Sophie; Berger, Angelika; Pollak, Arnold; Olischar, Monika.
in: PEDIATRICS, Jahrgang 132, Nr. 1, 01.07.2013, S. e211-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Successful implementation of a neonatal pain and sedation protocol at 2 NICUs
AU - Deindl, Philipp
AU - Unterasinger, Lukas
AU - Kappler, Gregor
AU - Werther, Tobias
AU - Czaba, Christine
AU - Giordano, Vito
AU - Frantal, Sophie
AU - Berger, Angelika
AU - Pollak, Arnold
AU - Olischar, Monika
PY - 2013/7/1
Y1 - 2013/7/1
N2 - OBJECTIVE: To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs.METHODS: The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation.RESULTS: Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation.CONCLUSIONS: Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.
AB - OBJECTIVE: To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs.METHODS: The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation.RESULTS: Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation.CONCLUSIONS: Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.
KW - Analgesics, Opioid
KW - Attitude of Health Personnel
KW - Austria
KW - Clinical Protocols
KW - Combined Modality Therapy
KW - Conscious Sedation
KW - Cooperative Behavior
KW - Curriculum
KW - Dose-Response Relationship, Drug
KW - Female
KW - Follow-Up Studies
KW - Guideline Adherence
KW - Health Plan Implementation
KW - Humans
KW - Infant, Newborn
KW - Inservice Training
KW - Intensive Care Units, Neonatal
KW - Interdisciplinary Communication
KW - Length of Stay
KW - Male
KW - Neonatal Nursing
KW - Nursing Assessment
KW - Pain Management
KW - Pain Measurement
KW - Quality Improvement
KW - Respiration, Artificial
KW - Software Design
KW - Tertiary Care Centers
U2 - 10.1542/peds.2012-2346
DO - 10.1542/peds.2012-2346
M3 - SCORING: Journal article
C2 - 23733799
VL - 132
SP - e211-8
JO - PEDIATRICS
JF - PEDIATRICS
SN - 0031-4005
IS - 1
ER -