Implementing use of sucrose analgesia (non-pharmacological management of neonatal pain) in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology

Abstract

BackgroundNeonatal pain not only has negative impact on the acute physiological parameters of the neonate but also has got the potential to cause long-term neurodevelopmental disabilities. However, neonatal pain especially related to procedures is not well recognised and often poorly managed in neonatal intensive care unit (NICU).Local problemOral sucrose solution became available commercially in late 2017 and this provided us the opportunity to alleviate some of the procedural pain in neonates admitted in our NICU.MethodsPoint of care quality improvement method (POCQI) was leveraged to identify root causes, change ideas and solutions were tested using PDSA cycles. Four procedures were selected by team for sucrose analgesia namely intravenous cannula insertion, tracheal suctioning, removal of tapes and phlebotomy. Change ideas tested included training of staff and doctors, providing dosage chart in NICU, method of administration of sucrose, affixing sucrose vial to baby bed, using prefilled sucrose syringe and bedside availability of sucrose and checklist for documentation. The study was conducted over a period of 8 weeks from 15 June 2017 on all eligible babies getting admitted.AIM statementWe aim to increase compliance to administration of sucrose analgesia to all eligible newborns (undergoing 4 selected procedures intravenous cannula insertion, tracheal suctioning, removal of tapes and phlebotomy) in NICU prior to painful procedure from current 0% to >80% by 8 weeks.ResultsThis quality improvement study implementing the use of evidence-based sucrose analgesia using PDSA cycles found that percentage of babies getting sucrose analgesia has increased from baseline 0% to 96.27% in the study period and is sustained at >80% for 4 years.ConclusionsPOCQI methodology can be used effectively to implement a new simple strategy of administering oral sucrose solution to address procedural pain in care pathway of neonates admitted in NICU. Sustaining the gains achieved by POCQI needs active leadership involvement and addressing adaptive or behavioural challenges with solutions like team huddles.

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

“…The established NICU strategies discussed here are not know to parents or are not suggested to them [ 112 ], There is a clear need to extend parents’ use and knowledge of non-pharmacological pain management methods to manage their infants’ procedural pain in the NICU [ 112 ] as further indicated by a recent systematic review on the clinical practive guidelines [ 10 ] by providing guidance and training for a more active involvement into their child’s care while in NICU [ 113 , 114 ] and in using pain scales and adequate methods of pain prevention or relief depending on pain severity. Also POCQI methodology for the acceptance of new methods in NICU as illustrated [ 99 ] can be an equally powerful tool for pain management by training and conditioning NICU staff on short but precise processes, that can be passed on to parents as well.…”

“…Short duration of the sucrose administration pain relief effect has been reported previously [ 95 , 96 ]. NNS usage in the contex of Point of care quality improvement method (POCQI) using a commercially fixed dosage oral sucrose solution gave a 96% rise in NNS use, in a level 3 NICU in India [ 99 ].…”

Estudos Multidisciplinares Sobre Saúde Da Criança E Do Adolescente

“…As respostas fisiológicas aos estímulos dolorosos se apresentam com o aumento agudo da frequência cardíaca, pressão arterial, variabilidade da frequência cardíaca, pressão intracraniana e diminuição da saturação arterial de oxigênio. Essas alterações na fisiologia dos neonatos são de magnitude e rapidez significativas para produzir lesões de perfusão e congestão venosa, levando a hemorragia intraventricular e/ou leucomalácia periventricular (DESAI et al, 2017;SAWLESHWARKAR et al, 2022).…”

“…Adicionalmente, o uso indiscriminado de medicamentos sedoanalgésicos como fentanil e morfina, podem causar sintomas como depressão respiratória, náuseas, convulsões e dependência fisiológica, impedindo o terapeuta de utilizá-las rotineiramente devido aos seus efeitos colaterais (DESAI et al, 2017). Sawleshwarkar et al, (2022), por meio do estudo utilizando o método de melhoria da qualidade no ponto de atendimento (POCQI) num período de 8 semanas para o implemento do uso de analgesia com sacarose em uma unidade neonatal, encontraram resultados sobre o uso da analgesia com sacarose com uma adesão de 0% para 96,27%, mantendo-se >80% durante 4 anos, associada à intervenção educativa como forma de capacitação da equipe de saúde, participação ativa da liderança da clínica e reuniões para abordagem dos desafios adaptativos a fim de perpetuar os ganhos obtidos através da intervenção.…”

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

“…Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach 16 Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital 18 Quality improvement in Kangaroo Mother Care: learning from a teaching hospital 26 Implementing use of sucrose analgesia in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology 20…”