Thacker Jigar P, Shah Deep S, Patel Dipen V, Nimbalkar Somashekhar M
Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Dist. Anand, Gujarat, India.
Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Dist. Anand, Gujarat, India.
Int J Pediatr. 2022 Feb 13;2022:8605071. doi: 10.1155/2022/8605071. eCollection 2022.
Although the benefits of pain control measures in neonates are well known, the actual usage was not optimal in our unit. Therefore, we implemented a quality improvement project to improve pain management practices through multiple Plan-Do-Study-Act (PDSA) cycles.
Our project included hemodynamically stable newborns weighing ≥1300 g. We identified four common procedures: intravenous cannulation, venous sampling, heel prick, and nasogastric tube insertion. The selected pain control measures were skin-to-skin contact, breastfeeding, expressed breast milk orally, and oral sucrose. Between April 2019 and September 2019, we intervened multiple times and reassessed shortcomings. We encouraged evidence-based practices and gave solutions for shortcomings. Data were interpreted weekly to assess the compliance to pain control interventions.
Minimal pain control measures (3-4%) were utilized for identified procedures before the project began. We could improve the use of pain control measures steadily and achieve the target of 80% of procedures after seven different interventions over five months. There was a retention of the effect on reassessing twice at second and fourth months of stopping further intervention once the target got achieved.
Quality Improvement science can identify the shortcomings and help to improve the compliance for pain control practices in neonates, as demonstrated in this neonatal unit.
尽管新生儿疼痛控制措施的益处广为人知，但在我们科室实际使用情况并不理想。因此，我们实施了一项质量改进项目，通过多个计划-实施-研究-改进（PDSA）循环来改善疼痛管理实践。
我们的项目纳入了体重≥1300克、血流动力学稳定的新生儿。我们确定了四种常见操作：静脉置管、静脉采血、足跟采血和鼻胃管插入。选定的疼痛控制措施为皮肤接触、母乳喂养、口服挤出的母乳和口服蔗糖。在2019年4月至2019年9月期间，我们多次进行干预并重新评估不足之处。我们鼓励循证实践并针对不足之处给出解决方案。每周对数据进行解读，以评估对疼痛控制干预措施的依从性。
在项目开始前，针对已确定的操作使用的疼痛控制措施极少（3%-4%）。经过五个月的七次不同干预，我们能够稳步提高疼痛控制措施的使用，并实现了80%的操作达到该目标。在达到目标后停止进一步干预，在第二个月和第四个月再次评估时效果得以维持。
如本新生儿科室所示，质量改进科学能够识别不足之处，并有助于提高新生儿疼痛控制实践的依从性。
