title: A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan.
abstract: BACKGROUND
  Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan.
  
  
  OBJECTIVE
  To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs).
  
  
  METHODS
  Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months).
  
  
  RESULTS
  Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions.
  
  
  CONCLUSIONS
  The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs.
  
  
  CONCLUSIONS
  Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting.
authors.affiliation: Midwifery and Maternal-Child Nursing, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan (Drs Ozawa and Oohira, Ms Funaba, and Ms Fukushima); Professor Emeritus, Hiroshima University, Hiroshima, Japan (Dr Yokoo); Department of Neonatology, Prefectural Hospital of Hiroshima, Hiroshima, Japan (Dr Fukuhara); Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama, Japan (Ms Uchida); Perinatal Center, Yamagata Prefectural Central Hospital, Yamagata, Japan (Dr Aiba); Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan (Ms Doi); Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan (Dr Akira Nishimura); Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan (Dr Hayakawa); and Department of General Perinatology and Neonatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan (Dr Yutaka Nishimura).
authors.forename: Mio
authors.initials: M
authors.lastname: Ozawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yokoo
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Funaba
authors.forename: Sayo
authors.initials: S
authors.lastname: Fukushima
authors.forename: Rie
authors.initials: R
authors.lastname: Fukuhara
authors.forename: Mieko
authors.initials: M
authors.lastname: Uchida
authors.forename: Satoru
authors.initials: S
authors.lastname: Aiba
authors.forename: Miki
authors.initials: M
authors.lastname: Doi
authors.forename: Akira
authors.initials: A
authors.lastname: Nishimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Oohira
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007564:Japan; D017283:Neonatal Nursing; D000072156:Neonatologists; D059408:Pain Management / Q000379:methods*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration