Reducing Opioid Exposure in a Level IV Neonatal Intensive Care Unit.

Autor:	Stetson RC; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Smith BN; Department of Pharmacy Services, Mayo Clinic, Rochester, Minn., Sanders NL; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Misgen MA; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Ferrie LJ; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Schuning VS; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Schuh AR; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn., Fang JL; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn., Brumbaugh JE; Division of Neonatal Medicine, Mayo Clinic, Rochester, Minn.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2020 Jun 26; Vol. 5 (4), pp. e312. Date of Electronic Publication: 2020 Jun 26 (Print Publication: 2020).
DOI:	10.1097/pq9.0000000000000312
Abstrakt:	Introduction: Infants in neonatal intensive care units require painful and noxious stimuli as part of their care. Judicious use of analgesic medications, including opioids, is necessary. However, these medications have long- and short-term side effects, including potential neurotoxicity. This quality improvement project's primary aim was to decrease opioid exposure by 33% in the first 14 days of life for infants less than 1,250 g at birth within 12 months. Methods: A multidisciplinary care team used Define, Measure, Analyze, Improve, Control methodology to identify root causes of the quality gap including: (1) inconsistent reporting of objective pain scales; (2) variable provider prescribing patterns; and (3) variable provider bedside assessment of pain. These root causes were addressed by two interventions: (1) standardized reporting of the premature infant pain profile scores and (2) implementation of an analgesia management pathway. Results: Mean opioid exposure, measured in morphine equivalents, in infants less than 1,250 g at birth during their first 14 days of life decreased from 0.64 mg/kg/d (95% confidence interval 0.41-0.87) at baseline to 0.08 mg/kg/d (95% confidence interval 0.03-0.13) during the postintervention period ( P < 0.001). There was no statistical difference in rates of days to full feedings, unintentional extubations, or central line removals between epochs. Conclusions: Following the implementation of consistent pain score reporting and an analgesia management pathway, opioid exposure in the first 14 days of life for infants less than 1,250 g was significantly reduced by 88%, exceeding the project aim. (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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