Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S87-S94 (doi:10.1542/peds.2006-0913E)
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ARTICLE


Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates

Alston E. Dunbar, III, MDa, Paul J. Sharek, MD, MPHb, Nick A. Mickas, MDc, Kara L. Coker, RN, MSd, Jill Duncan, RN, MSN, MPHe, Debra McLendonf, Claire Pagano, RN, MGAe, Teresa D. Puthoff, PharmDg, Natalie L. Reynolds, RNh, Richard J. Powers, MDc and C. Celeste Johnston, DEd, RNi

a Division of Neonatology, Woman's Hospital, Baton Rouge, Louisiana
b Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
c Division of Neonatology, Children's Hospital of Oakland, Oakland, California
d DeVos Children's Hospital, Grand Rapids, Michigan
e Inova Fairfax Hospital for Children, Falls Church, Virginia
f New Hanover Regional Medical Center, Wilmington, North Carolina
g Miami Valley Hospital, Dayton, Ohio
h Wesley Medical Center, Wichita, Kansas
i School of Nursing, McGill University, Montreal, Quebec, Canada

OBJECTIVE. Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process.

METHODS. Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These centers developed and implemented evidence-based potentially better practices for pain management and sedation in neonates. The group introduced changes through plan-do-study-act cycles and tracked performance measures throughout the process.

RESULTS. Strategies for implementing potentially better practices varied between centers on the basis of local characteristics. Individual centers identified barriers to implementation, developed tools for improvement, and shared their experience with the collaborative. Baseline data from the 12 sites revealed substantial opportunities for improved pain management, and local potentially better practice implementation resulted in measurable improvements in pain management at participating centers.

CONCLUSIONS. The use of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices at participating centers.

Key Words: collaborative quality improvement • multidisciplinary • neonatal intensive care • NIC/Q 2002 • pain • neonate

Abbreviations: NIC/Q 2002—Neonatal Intensive Care Quality Improvement Collaborative 2002 • PBP—potentially better practice • ETT—endotracheal tube • IFHC—Inova Fairfax Hospital for Children • NPO—nothing by mouth • WMC—Wesley Medical Center • LPCH—Lucile Packard Children's Hospital • N-PASS—Neonatal Pain, Agitation, and Sedation Scale • PRN—pro re nata • DVCH—DeVos Children's Hospital

Accepted Jul 18, 2006.