N-PASS Scores

[TeenyTinyBabyRN, BSN, RN]

We are supposed to evaluate patients before and after giving a PRN medication. Right now we only use CRIES and PIPPS scores, but we can only use them to evaluate pain and pain medication effectiveness and cannot use them for our "agitation" medications (Versed and Ativan). The only way, right now for us to evaluate our "agiation" medications is to write a note describing the baby's behavior and vital signs before and after the medication, which we find to be quite tedious.

I was wondering if any of you use N-PASS scores for pain and sedation and how you feel about it. Do you find it effective for both pain and sedation purposes? Do you feel that this score can replace the CRIES and PIPPS scores?

[fulitarn, BSN, RN]

We use NPASS and it is very effective. We do a pain rating with every care time, and before/after a procedure. Any pain rating greater than 2 requires a reevaluation after 1 hour. You do take into consideration the points baby gets for prematurity, so a 25 week baby will score a 3 every time, and only a score >5 requires reevaluation.

We don't always use it for sedation, although we can. And there is nursing judgment there. If a baby who is sedated and consistently scoring -5 suddenly scores 0 and is agitated, you can say the baby needs more pain meds/sedation because of the drastic change, even with the pain score of 0.

[MNNICU, RN]

We use NPASS and also sedation scores for our sedated patients. I find sometimes that our docs will prescribe anti anxiety meds but not always pain meds which makes no sense to me. I recently had a 31 week patient with bilateral chest tubes and on an oscillator and had to argue with the doc for a morphine order to go with my versed. Then the nurses weren't even giving it. I get report in the am that the baby "seemed fine" throughout the night and only got versed. When I came in to get report at the bedside his heart rate was 220 and he was grimacing and trying to cry while intubated. I was extremely upset and immediately have morphine and wrote a patient safety report about it. In my mind pain is way under treated in our population. Especially when nurses and doctors are sedating them with versed so they can't cue that they are in major pain. Ugh it's awful

[TiffyRN, BSN, PhD]

In my mind pain is way under treated in our population. Especially when nurses and doctors are sedating them with versed so they can't cue that they are in major pain. Ugh it's awful

Wow. I wish I could share a presentation by one of our neos. Short version: untreated pain: bad neurodevelopmental outcomes. Opioids for pain: uncertain long-term effects, probably worth the risk. Benzos: poorer neurodevelopmental outcomes, and they know the mechanism, it has two byproducts, one that promotes apoptosis, and one that inactivates an inhibitor for apoptosis. Give only if you really don't have an option.

I saw this same neo just a few days later dealing with a sick sick late preterm kid. Several chest tubes and several types of ventilation trials before she made the turn around. He passed out the meds liberally, including benzos, but you could tell it was a hard decision. Kid went home about a month later, we won't know the rest of the story for years is the thing.

[BittyBabyGrower, MSN, RN]

It is truly a rock and a hard place. The meds can cause issues, untreated agitation and pain cause issues. Hopefully you can find the happy medium.