Mapping pain assessment and management in a surgical neonatal intensive care unit: A process for best practice
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Aim: To describe a process for mapping current practice within the neonatal intensive care unit (NICU) to inform practice change. There are evidence based recommendations for practices concerning neonatal pain. Despite these guidelines, there continues to be poor utilisation of evidence to guide pain assessment and management in the NICU.
Methods: This study mapped current practices for postoperative pain assessment and management in one surgical NICU. Patient records of postoperative neonates were examined using a retrospective chart review to determine if knowledge was transferred into practice through compliance with clinical practice guidelines.
Results: Compliance with the clinical guideline was poor. Pain assessments were under-recorded for the five days following surgery. There were no differences for preterm, wound location or type of surgery (p > 0.05). The mean duration in hours of opioid infusions varied, fentanyl (63 - range 11-117) and morphine (37 - range 5-106). In 50% the opioid was ceased with extubation. Weaning practices were inconsistent, an opioid weaning score was attended in less than 30% of neonates.
Conclusions: Despite the availability of clinical practice guideline, pain practices remain inconsistent; however, improved compared to previous studies. Recommendations following this study include raising awareness about postoperative pain, revising the guideline and providing education for pain management techniques.