Implementation of a neonatal pain management module in the computerized physician order entry system

Abstract

BackgroundDespite the recommended guidelines, the neonatal management of pain and discomfort often remains inadequate. The purpose of the present study was to determine whether adding a pain and discomfort module to a computerized physician order entry (CPOE) system would improve pain and discomfort evaluation in premature newborns under invasive ventilation.MethodsAll newborns <37 weeks gestational age (GA) and requiring invasive ventilation were included in a prospective study during two 6-month periods: before and after the inclusion of the pain and discomfort evaluation module. The main outcome measure was the percentage of patients having at least one assessment of pain and discomfort per day of invasive ventilation using the COMFORT scale.ResultsA total of 122 patients were included: 53 before and 69 after the incorporation of the module. The mean age was 30 (3) weeks GA. After the module was included, the percentage of patients who benefited from at least one pain and discomfort assessment per day increased from 64% to 88% (p < 0.01), and the mean number (SD) of scores recorded per day increased from 1 (1) to 3 (1) (p < 0.01). When the score was not within the established range, the nursing staff adapted analgesia/sedation doses more frequently after module inclusion (53% vs. 34%, p < 0.001). Despite higher mean doses of midazolam after module introduction [47 (45) vs. 31 (18) μg/kg/hr, p < 0.05], the durations of invasive ventilation and hospital stay, and the number of nosocomial infections, were not significantly modified.ConclusionsAdding a pain and discomfort tool to the CPOE system was a simple and effective way to improve the systematic evaluation of premature newborns who required ventilatory assistance.

Perfusion index and its dynamic changes in preterm neonates with patent ductus arteriosus

“…In paediatrics, two recent studies reported controversial results about the accuracy of dynamic variables derived from the plethysmographic waveform to predict fluid responsiveness for mechanically ventilated patients under general anaesthesia (21,22). In neonatology, a median PVI value of 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)% was recently reported in spontaneously breathing-term neonates on the first day of life, mainly influenced by the behavioural status of the newborn (23). Our study is the first to record PVI values in premature neonates during IPPV, but these conditions did not result in major differences regarding the PVI data.…”

“…Plethysmographic variability index was 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27). None of the perinatal characteristics listed in Table 1, including postnatal age, had a significant influence on PVI.…”

Impact of the Electronic Medical Record on Mortality, Length of Stay, and Cost in the Hospital and ICU

“…Of the studies, five described electronic health record systems (11)(12)(13)(14)(15), 11 CPOE (16-26), 17 CDS systems (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), six surveillance systems or "sniffers" (44)(45)(46)(47)(48)(49), and six electronic medication reconciliation tools not fitting into the prior categories (50)(51)(52)(53)(54)(55). Almost all of the studies were peri-implementation designs comparing preintervention with postintervention.…”

“…Of the studies addressing ICU mortality as an endpoint, there were four using CPOE systems (17,19,20,23), three CDS (30,34,40), and two sniffers (46,47). Heterogeneity was high in all subgroups and none trended toward a significant effect.…”

“…Hospital LOS was evaluated by eight studies (17,21,22,24,27,33,34,46), including four CPOE studies (17, 21, 22, 24), one sniffer (46), and three CDS systems (27,33,34). CPOE trended toward a reduction in LOS (mean decrease, 0.67 d; 95% CI, -2.07 to 0.73), though with significant heterogeneity (I 2 = 82%).…”