Decreasing the Inappropriate Use of Pain and Sedation Medications in a Level III NICU

Background: Overuse of pain and sedation medications continue to be a problem in newborn intensive care units (NICU). The use of pain and sedation medications can have harmful long term neurodevelopmental sequlae and these medications should only be used when nonpharmacological interventions are not justified. The purpose of this quality improvement project was to reduce unnecessary exposure of infants in the NICU to pain and sedation medications whose NPASS scores do not justify their administration.Methods: This quality improvement project used preintervention data from an electronic health record (EHR) review of 35 infant charts to assess the current administration of pain and sedation medications in relation to NPASS scores in this NICU prior to project implementation. A guideline was developed using an abbreviated form of the NPASS tool as its basis. Several staff educational sessions were held to re-educate NICU nurses (52% of nurses attended education) on proper use the NPASS tool and interpretation of results regarding whether to medicate or use nonpharmacologic interventions instead. Electronic health records from 28 infant charts were auditied following guideline implementation in the interim eight weeks to compare to pre-implementation data. An independent samples t-test was peformed to determine whether pain and sedation administration without justifiable NPASS scores was reduced.Results: Although total pain and sedation medication exposure was not assessed, results from pre- and post-intervtion chart reviews revealed a 43% decrease (p = <0.01) in improperly administered pain and sedation medications. Missing NPASS scores were 2 found in 20 charts reviewed prior to project implementation and only 1 following project implementation.Conclusion: The re-education and implementation of the guideline in this unit was shown to be useful in reducing the inappropriate use of pain and sedation medication used in this NICU when NPASS scores do not justify using them. Ongoing surveillance with chart audits will need to be performed to monitor nursing practices in pain assessment and medication administration to determine areas for improvement. Making the training and use of the guideline mandatory may increase staff uptake of proper scoring practices and improve their interpretation regarding need for pain and sedation medication. Making the guideline part of nursing orientation for new employees should also be considered. Additional training around non-pharmacological interventions and comfort measures may also reduce the administration of medications to neonates.