Successful implementation of a neonatal pain and sedation protocol at 2 NICUs

Autor: Angelika Berger, Arnold Pollak, Lukas Unterasinger, Philipp Deindl, Tobias Werther, Gregor Kappler, C. Czaba, Vito Giordano, Sophie Frantal, Monika Olischar
Rok vydání: 2013
Předmět:
Male
medicine.medical_specialty
Inservice Training
Attitude of Health Personnel
Sedation
medicine.medical_treatment
Analgesic
Conscious Sedation
Tertiary Care Centers
Clinical Protocols
Interquartile range
Software Design
Intensive care
Intensive Care Units
Neonatal
Neonatal Nursing
Health care
medicine
Humans
Pain Management
Medical prescription
Cooperative Behavior
Nursing Assessment
Pain Measurement
Mechanical ventilation
Dose-Response Relationship
Drug
business.industry
Health Plan Implementation
Infant
Newborn
Length of Stay
Combined Modality Therapy
Quality Improvement
Respiration
Artificial
Analgesics
Opioid
Anesthesia
Austria
Pediatrics
Perinatology and Child Health
Emergency medicine
Morphine
Female
Interdisciplinary Communication
Curriculum
Guideline Adherence
medicine.symptom
business
medicine.drug
Follow-Up Studies
Zdroj: Pediatrics. 132(1)
ISSN: 1098-4275
Popis: OBJECTIVE: To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. METHODS: The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. RESULTS: Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5–5.9] mg/kg versus intervention group dose of 2.7 [0.4–57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2–10] vs 6 [2–13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation. CONCLUSIONS: Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.
Databáze: OpenAIRE
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