Assessment and improvement of neonatal analgesia in a District General Neonatal Intensive Care Unit (DGH NICU)

Gerard McCabe1, Hillary Conetta1

1) United Kingdom

Aim: Compare clinical practice in a DGH NICU to guidelines in relation to neonatal analgesia.

GG&C Guidelines Summary: Sucrose 24% oral solution, as well as comforting measures, should be prescribed and given to all neonates and infants undergoing procedures known to cause pain and discomfort unless contraindicated.

Method:

1. Audit sucrose prescribing in NICU in the Royal Alexandra Hospital over a 2-week period.
2. Survey the knowledge and adherence of the guidelines with all junior medical staff working on the selected wards during this period.
3. Implement changes

Results:

26 neonates were investigated. None of these neonates had been prescribed or administered the appropriate sucrose during their admission.

16 Junior Medical Staff had been surveyed as to their knowledge of local Guidelines. 6 junior staff were completely unaware of the guidelines. ( Tables and graphs available)

Interpretation of Results:

• Not a single patient had a recorded administration of sucrose
• Almost 1/3 of junior medical staff are unaware of current guidelines
• No junior medical staff administer sucrose every time they carry out a painful procedure although 43.75% state they give it most of the time.
• Over half of junior medical staff say they hardly ever/never give sucrose
• Over 81.8% of those who give administer sucrose state they hardly ever/never prescribe it on the kardex.

Interventions:

• Sucrose 24% was moved from the controlled drugs cupboard and into each of the trolleys used for procedural equipment after discussions with pharmacy.
• The guidelines were added to the induction pack for new doctors and posters were placed in the doctor’s office and in clinical areas.
• The ward sister informed nursing staff of the current guidelines.

Re audit results:

Following the new interventions 16 neonates were audited. All 16 babies had documented analgesia. All staff were aware of the guidelines.