Plans to reduce pain in the neonatal intensive care unit NICU

[Dave ARNP]

[Plans to reduce pain in the neonatal intensive care]

[Article in German]

Hubler A.

Klinik fur Kinder- und Jugendmedizin der Friedrich-Schiller-Universitat Jena. [email protected]

Prolonged pain influences behaviour and physiological regulation in preterm infants undergoing intensive care. Insufficient pain treatment results in increased morbidity and mortality. Long-term consequences of stress and pain yet are not clear, but associations with neurobehavioral and developmental sequelae are discussed. A number of psychometric constructs (pain scales) are available to identify pain indicators. These pain scales represent the basis to consider treatment strategies. Main indications are painful interventional procedures, analgesia during mechanical ventilation and the reduction of pain following surgery. Supporting approaches to reduce pain and stress relate to infant's behaviour, care of the professionals and improvement of "infant's world". Pharmacologic interventions are practicable with acetaminophen in mild pain and with opioid drugs (fentanyl and morphine) in moderate and severe pain. A pure or complementary sedative agent can provide physiological stability in settings in which there are less acutely painful stimuli. After standard pain evaluation it is necessary to individualize treatment, to monitor clinical situation and to adjust dosage. Actual knowledge allows an effective reduction of pain even in very premature infants. Because of lack of clarity about early development of pain and stress reactivity at the time it is necessary to estimate benefits against potential risks of therapy.

PMID: 14689328 [PubMed - in process]

http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48dde4a73e09a969852568880078c249&c=&newsid=8525697700573E1885256E06003A4799&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=14689328&ref=/news/content.nsf/SearchResults?openform&Query=actiq&so=date&id=48dde4a73e09a969852568880078c249

[prmenrs, RN]

We do for term babies. It is much easier to use, and, IMO, more accurate.

[exosurf]

How many NICU's out there use the N-PASS? Is it easy to use and self explanatory? Does anyone have any info about it (like research articles) besides the N-PASS.com site? WE use the CRIES and I don't like it.

We've used the N-PASS for 2 years now and love it. It's very simple to use and addresses gestational age as well. Another great thing is that there is a sedation assessment with the tool as well, so you know if you're under or over sedating a baby. VERY useful post op and with really sick kids who need to be heavily sedated on the vent but they don't want paralysis.

http://n-pass.com/

The tool is on this site, which is very informative.

:)

[exosurf]

How many NICU's out there use the N-PASS? Is it easy to use and self explanatory? Does anyone have any info about it (like research articles) besides the N-PASS.com site? WE use the CRIES and I don't like it.

We've used the N-PASS for 2 years now and love it. It's very simple to use and addresses gestational age as well. Another great thing is that there is a sedation assessment with the tool as well, so you know if you're under or over sedating a baby. VERY useful post op and with really sick kids who need to be heavily sedated on the vent but they don't want paralysis.

http://n-pass.com/

The tool is on this site, which is very informative.

:)

[NICU_Nurse, BSN, RN]

Well, we use ATTIA, which is AWFUL, IMO. I'm going to present this at work and see what happens. Anyone have any additional information, aside from the original web site?

[NICU_Nurse, BSN, RN]

Well, we use ATTIA, which is AWFUL, IMO. I'm going to present this at work and see what happens. Anyone have any additional information, aside from the original web site?

[prmenrs, RN]

I have not used N-PASS, but on thte surface, it certainly looks easier than that darn PIPPs.

[prmenrs, RN]

I have not used N-PASS, but on thte surface, it certainly looks easier than that darn PIPPs.

[Gompers, BSN, RN]

At this point there isn't a whole lot of information out there about N-PASS becuase it's so new. The research done on it a couple of years ago is summarized on the website, and I believe a lengthy research article is going to be published soon. So at this point, most of the information you can get about it is found on their website. The tool is pretty self explanitory, but they explain how to use it on the site. If your manager is interested in using it, you have to contact the creators though, as it is copyrighted information.

http://n-pass.com/assesment_table.html

The thing we like about it is that there is a sedation tool as well. You can only assess sedation when you do hands-on vital signs, because you have to see how the baby responds to stimulation. It's a negative number, with -10 being totally unconsious. Most of the kids are a ZERO for this - sleep until you bother them, then act appropriately. But sometimes, esp. after surgery, they'll want kids more sedated, but not paralyzed. So it's nice to have some parameters to judge how sedated they are. And of course, you always worry about the kid who isn't on ANY pain meds and is a -5 or something!!!

For pain, it's a positive number, and anything over a 3 is considered enough to require analgesia of some sort, and an hour later a reassessment should be made. We use the current gestational age of each infant, and add points to their score depending on how premature they are. For instance, a baby currently under 28 weeks already has a score of 3, before you even check them for pain. So yes, we do give analgesia to most of those kids around the clock to keep them comfortable. There has been some disagreement about that practice at times, but when you consider their raw nervous systems, it does make more sense. Plus, most micropreemies don't respond normally to pain - as most of you know, sometimes they just don't react at all and kind of go into their own little world because it's just too much to handle - but you know they must still be in pain! Most of our kids under 28 weeks are vented anyways, and our policy is for ALL vented kids to get something for pain around the clock.

We've been using it for awhile now, so feel free to ask questions! I'd definitely show it to your managers if you like it and then contact the authors.

[Gompers, BSN, RN]

At this point there isn't a whole lot of information out there about N-PASS becuase it's so new. The research done on it a couple of years ago is summarized on the website, and I believe a lengthy research article is going to be published soon. So at this point, most of the information you can get about it is found on their website. The tool is pretty self explanitory, but they explain how to use it on the site. If your manager is interested in using it, you have to contact the creators though, as it is copyrighted information.

http://n-pass.com/assesment_table.html

The thing we like about it is that there is a sedation tool as well. You can only assess sedation when you do hands-on vital signs, because you have to see how the baby responds to stimulation. It's a negative number, with -10 being totally unconsious. Most of the kids are a ZERO for this - sleep until you bother them, then act appropriately. But sometimes, esp. after surgery, they'll want kids more sedated, but not paralyzed. So it's nice to have some parameters to judge how sedated they are. And of course, you always worry about the kid who isn't on ANY pain meds and is a -5 or something!!!

For pain, it's a positive number, and anything over a 3 is considered enough to require analgesia of some sort, and an hour later a reassessment should be made. We use the current gestational age of each infant, and add points to their score depending on how premature they are. For instance, a baby currently under 28 weeks already has a score of 3, before you even check them for pain. So yes, we do give analgesia to most of those kids around the clock to keep them comfortable. There has been some disagreement about that practice at times, but when you consider their raw nervous systems, it does make more sense. Plus, most micropreemies don't respond normally to pain - as most of you know, sometimes they just don't react at all and kind of go into their own little world because it's just too much to handle - but you know they must still be in pain! Most of our kids under 28 weeks are vented anyways, and our policy is for ALL vented kids to get something for pain around the clock.

We've been using it for awhile now, so feel free to ask questions! I'd definitely show it to your managers if you like it and then contact the authors.

[exosurf]

Thanks Gompers for your reply!! Really helps!

At this point there isn't a whole lot of information out there about N-PASS becuase it's so new. The research done on it a couple of years ago is summarized on the website, and I believe a lengthy research article is going to be published soon. So at this point, most of the information you can get about it is found on their website. The tool is pretty self explanitory, but they explain how to use it on the site. If your manager is interested in using it, you have to contact the creators though, as it is copyrighted information.

http://n-pass.com/assesment_table.html

The thing we like about it is that there is a sedation tool as well. You can only assess sedation when you do hands-on vital signs, because you have to see how the baby responds to stimulation. It's a negative number, with -10 being totally unconsious. Most of the kids are a ZERO for this - sleep until you bother them, then act appropriately. But sometimes, esp. after surgery, they'll want kids more sedated, but not paralyzed. So it's nice to have some parameters to judge how sedated they are. And of course, you always worry about the kid who isn't on ANY pain meds and is a -5 or something!!!

For pain, it's a positive number, and anything over a 3 is considered enough to require analgesia of some sort, and an hour later a reassessment should be made. We use the current gestational age of each infant, and add points to their score depending on how premature they are. For instance, a baby currently under 28 weeks already has a score of 3, before you even check them for pain. So yes, we do give analgesia to most of those kids around the clock to keep them comfortable. There has been some disagreement about that practice at times, but when you consider their raw nervous systems, it does make more sense. Plus, most micropreemies don't respond normally to pain - as most of you know, sometimes they just don't react at all and kind of go into their own little world because it's just too much to handle - but you know they must still be in pain! Most of our kids under 28 weeks are vented anyways, and our policy is for ALL vented kids to get something for pain around the clock.

We've been using it for awhile now, so feel free to ask questions! I'd definitely show it to your managers if you like it and then contact the authors.

[nekhismom]

We don't use any standardized tool. Well, not NATIONALLY standardized. I think our tool is standard to our entire hospital, not nicu specific. It's a PITA, too. And most of our nurses either chart no pain or a pain score of less than 5, with 5 being the lowest score requiring intervention. :angryfire:

I think if our nurses were better educated about pain assessment in neonates, and preemies in particular, and we had a better tool, we would have MUCH better pain management.