title: Successful implementation of a neonatal pain and sedation protocol at 2 NICUs.
abstract: 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.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neonatology, Intensive Care, and Neuropediatrics, Medical University of Vienna, Vienna, Austria. philipp.deindl@meduniwien.ac.at
authors.forename: Philipp
authors.initials: P
authors.lastname: Deindl
authors.forename: Lukas
authors.initials: L
authors.lastname: Unterasinger
authors.forename: Gregor
authors.initials: G
authors.lastname: Kappler
authors.forename: Tobias
authors.initials: T
authors.lastname: Werther
authors.forename: Christine
authors.initials: C
authors.lastname: Czaba
authors.forename: Vito
authors.initials: V
authors.lastname: Giordano
authors.forename: Sophie
authors.initials: S
authors.lastname: Frantal
authors.forename: Angelika
authors.initials: A
authors.lastname: Berger
authors.forename: Arnold
authors.initials: A
authors.lastname: Pollak
authors.forename: Monika
authors.initials: M
authors.lastname: Olischar
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D001317:Austria; D002985:Clinical Protocols / Q000592:standards; D003131:Combined Modality Therapy / Q000451:nursing; D016292:Procedural Sedation / Q000451:nursing / Q000592:standards*; D003299:Cooperative Behavior; D003479:Curriculum; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards; D006284:Health Plan Implementation / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training / Q000592:standards; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017283:Neonatal Nursing / Q000193:education / Q000592:standards; D009730:Nursing Assessment / Q000592:standards; D059408:Pain Management / Q000451:nursing / Q000592:standards*; D010147:Pain Measurement / Q000451:nursing / Q000592:standards; D058996:Quality Improvement / Q000592:standards; D012121:Respiration, Artificial / Q000592:standards; D012985:Software Design; D062606:Tertiary Care Centers
chemical_list: D000701:Analgesics, Opioid
keywords: N-PASS; Vienna Protocol for Neonatal Pain and Sedation; clinical practice guidelines; mechanical ventilation; quality improvement project