Successful implementation of a neonatal pain and sedation protocol at 2 NICUs

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 -