Richard van Lingen1, Hilko Hein1, Susanne M. de Tollenaer1
1) Netherlands
Introduction: The 10 Dutch Neonatal Intensive Care Units (NICU’s) are each making one national best practice guideline for all neonatal problems. Most therapies in neonates are not based on a high level of evidence, but we chose for uniformity and the best practice whenever possible. Our NICU started working on the pain assessment and therapy guideline
Objective: Creating uniformity in pain assessment and non-pharmacological and pharmacological therapy based on best practice and where possible on evidence based medicine
Methods: For the guideline on pain assessment and management we used the evidence based national guideline on pain and postsurgical pain in children, the local protocols from the 10 level III NICU’s, and the Neonatal Nurses on Pain protocol. For pain assessment the COMFORTneo scale and the VAS were advised and an algoritm for prescribing, monitoring, tapering and discontinuing medication was made.
Doses for the most common used analgesics, ie acetaminophen, morfine, fentanyl, local analgesics and sucrose were provided as well as the indications they could be used for, and their possible side effects.
First draft was send to the expert panel on guidelines and local representatives (ie a doctor and a nurse who were experts in pain) and comments were used for the final version
Results: Pain assessment by COMFORTneo and VAS is now done on all units resulting in painscores during every (8hrs) shift. Pain management improved as the right doses and indications are readily available
Conclusion: Although differences between centers and in interpretation between health care workers (neonatologists and NICU-nurses) will remain, we now have one national protocol available on all 10 NICU’s leading to quality improvement and uniformity. The protocol will be implemented on 80 neonatal wards during 2017.
Acknowledgement: Thanks to all members of the WLAN of the 10 NICU's for their cooperation
Disclosure: Nothing to disclose
