Plans to reduce pain in the neonatal intensive care unit NICU - page 2

Hubler A. Klinik fur Kinder- und Jugendmedizin der Friedrich-Schiller-Universitat Jena. Axel.Huebler@med.uni-jena.de Prolonged pain influences behaviour and physiological regulation in preterm... Read More

  1. by   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.





    Quote from Gompers
    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.

  2. by   NICU_Nurse
    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?
  3. by   prmenrs
    I have not used N-PASS, but on thte surface, it certainly looks easier than that darn PIPPs.
  4. by   Gompers
    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.
    Last edit by Gompers on Mar 19, '04
  5. by   exosurf
    Thanks Gompers for your reply!! Really helps!

    Quote from Gompers
    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.
  6. by   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.

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