Pain Assessment and Management Practices via Education and Reinforcement

A recent quality improvement initiative aimed to establish neonatal pain management practices as a crucial developmental supportive measure at a Neonatal Intensive Care Unit (NICU) in northern India. 

This study was conducted over 6 months and was followed by a 2-year sustenance phase. Infants with a birth weight of ≤1800 g were included. The Pain Assessment and Management Practices via Education and Reinforcement (PAMPER) group––comprising resident doctors and nursing staff––was formed; the Premature Infant Pain Profile score was utilized for pain assessment. Limiting factors were identified through a fishbone diagram, and multiple Plan-Do-Study-Act cycles were implemented as interventions.

Following interventions, all procedures were assessed for pain. It was noted that the mean documented pain score for the first seven days decreased from 12.8 (0.3) in the baseline phase to 7 (2.5). These low-cost interventions resulted in sustaining the practice in over 70% of infants over the subsequent 2 years. 

Thus, implementing the standard protocol, along with regular audits and reinforcement, significantly improved the pain assessment and management policy in the NICU.

Source: Upadhyay J, Soni S, Shubham S, Kumar S, Singh P, Basu S. Indian Journal of Pediatrics. 2023 Oct 11:1-7.