Standardizing Post-Operative Pain Management in the NICU: A Pilot Study

Background: The American Academy of Pediatrics recommends that all institutions have written pain management guidelines to standardize the management of neonatal pain to improve pain management practices and to increase patient safety. Despite the increased awareness and evidence-based recommendations, neonatal pain management remains a challenge. There is growing evidence indicating that medical opiate exposure is increasing over time in the NICU, likely due to the lack of standardized protocols, noncompliance with institutional guidelines, and variances in pain assessment and opioid prescribing practices. Due to the lack of standardization, a post-operative pain management guideline was developed, piloted and evaluated. Methods: A survey questionnaire was completed to assess the staff's knowledge and use of the N-PASS tool and opiate administration and prescribing practices. A retrospective chart review was conducted to assess pain management practices prior to piloting the new evidence-based guideline. Educational sessions regarding the guideline were offered to staff prior to its implementation. A chart review was conducted to evaluate the use and adherence to the new guideline and to compare total opiate exposure before and after piloting the guideline. Results: Pain assessments increased by 20% in the pilot group and accuracy increased from 26% to 91%. Total opioid exposure between the two groups was compared and the total mean opioid exposure increased in the pilot group; however, total benzodiazepine exposure decreased. Stakeholders identified multiple system inefficiencies and barriers to the nursing workflow during implementation. Conclusions: Implementation of an evidence-based consensus guideline to standardize post-operative pain management in the NICU increased the consistency and accuracy of neonatal pain assessments, but did not result in reduced opioid exposure.