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| A CLOSER LOOK: Members of the NICU unit-based council at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford in Bedford introduced evidence-based research to staff to improve pain management interventions in the NICU. courtesy Gretchen L. Umlor |
In the 16-bed level III NICU at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford in Bedford, our neonatal pain assessment and documentation were not being completed per the facility's policy and procedure guidelines. Pain management interventions were underutilized for invasive procedures. A review of patient charts was completed on all infants who were on our unit during the course of 1 month.
Our findings revealed the documentation of 319 invasive procedures. Out of the 319 procedures documented, 61 percent did not have any pain documentation and 67 percent lacked documentation of any pain intervention or pain reassessment.
Joint Commission Standard PC.2.04.0 states, "The organization assesses and manages patients for pain." Effective pain management requires thorough pain assessment by caregivers. Without assessment and documentation, it is difficult to assess the effectiveness of pain management interventions.
NICU unit-based council members Candy Bruton, BSN, RN, Layne Besgrove, BSN, RN, Sandi Price, ADN, Pam DuBreuil, BSN, RN, Allison Jones, BSN, RN, Harold Magee BSN, RN, and myself agreed to provide education about neonatal pain assessment and pain management. A series of educational offerings were provided to the nursing staff. The "NICU Policy and Procedure for Pain Assessment and Management (Infant) Manual" was reviewed with staff at a mandatory skills fair. One of the neonatal nurse practitioners gave a PowerPoint presentation on developmental care and neonatal pain she offered to present to staff on two separate occasions.
Deborah Behan, PhD, RN-BC, provided training on journal clubs and evidence-based practice (EBP). A professional journal club was held with current (past 5 years) research evidence. A search was made of evidence-based medicine journals, CINAHL and Cochrane Library through OVID, available to staff on the campus of Texas Health HEB via research databases on our Internet. A PowerPoint presentation included a Cochrane Systematic Review, a Cochrane Protocol, a guideline from the National Guideline Clearinghouse and several journal/research articles. This presentation contained information on sucrose and other nonpharmacological interventions. The National Association of Neonatal Nurses' Guideline: "Pain Assessment and Management" was also made available to the nursing staff.
Six months after initiating education for the staff, another retrospective review of patient charts was conducted. Of the 254 documented invasive procedures for that month, only 25 percent lacked documentation of pain assessment and 26 percent did not have any documentation of an assessment, intervention or reassessment of pain.
We then created an EBP abstract/poster and presented it at the Summer Institute on Evidence-Based Practice in San Antonio. We were given an opportunity to present again at the University of Texas in Arlington.
We wanted to see how well we were addressing pain 1 year later. We collected the data and found 34 percent had no pain assessment documented, but each time an assessment of pain was documented, the nurse also documented interventions and documented the reassessment for pain. This demonstrated to us that ongoing EBP education of nursing staff is essential for the safe and effective management of neonatal pain.
This was the NICU unit-based council's first attempt at presenting and utilizing EBP at the bedside in our unit. It was challenging, but it was also an excellent learning experience.
Gretchen L. Umlor is a NICU nurse at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford in Bedford.
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