Faculty Collaboration Database

A NICU Postoperative Pain Management Improvement Project to Reduce Uncontrolled Pain and Improve Staff Satisfaction. Adv Neonatal Care 2025 Feb 01;25(1):18-27

Date

01/01/2025

Pubmed ID

39739604

DOI

10.1097/ANC.0000000000001234

Scopus ID

2-s2.0-85214571376 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Postoperative pain management in the neonatal period is an area of high variability and a source of staff dissatisfaction. Pain management is a key component of high-quality care; however, pain assessment in infants is difficult and analgesics can negatively impact the developing brain.

PURPOSE: We aimed to improve postoperative pain control for infants in our neonatal intensive care unit (NICU), limit variability in the approach to pain management, and increase staff satisfaction.

METHODS: This project was completed between April 2019 and March 2022 with sustainment tracked through December 2023. Interventions took place in a 70-bed level IV NICU using quality improvement methodology. Interventions included efforts aimed at improving pain assessment as well as development and implementation of a pain management guideline. Outcome measures included frequency of uncontrolled postoperative pain and measures of staff satisfaction. Process measures included compliance with pain assessment cadence and guideline recommendations. Opioid exposure within 24 hours of surgery was included as a balancing measure.

RESULTS: Pain management was assessed in 811 infants: 392 prior to guideline implementation, 273 during implementation, and 146 during sustainment period. Uncontrolled postoperative pain decreased from 26% pre-implementation to 18% post implementation and into the sustainment period. Staff satisfaction improved from 67% to 83%. These improvements were associated with decreased variability in postoperative pain management and a decrease in postoperative opioid exposure.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The use of a postoperative pain management guideline can improve pain control, decrease drug regimen variability, decrease opioid exposure, and increase staff satisfaction.

Author List

Sprecher A, Roeloffs K, Czarnecki ML, Labovsky K, Kissell A, Hornung G, Uhing M

Authors

Kristen Labovsky MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Alicia Sprecher MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Analgesics, Opioid
Female
Guideline Adherence
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Job Satisfaction
Male
Pain Management
Pain Measurement
Pain, Postoperative
Practice Guidelines as Topic
Quality Improvement