Abstract
Purpose: The purpose of this quality improvement project is to create and implement pain and sedation guidelines to reduce the cumulative exposure to opioids, benzodiazepines, and dexmedetomidine in intubated neonates born less than 28 weeks’ gestation.|Background: Despite advancements aiding in increased survival rate, premature neonates are at high risk for developmental, cognitive, and physical delays. In the NICU, they are subjected to stressful events that cause pain. Mechanically ventilated neonates are exposed to higher levels of pain due to their acuity. While nonpharmacologic therapy is preferred for the treatment of pain and sedation, often pharmacologic therapy is needed. Despite the ability of pharmacologic therapies ability to alleviate pain and provide sedation, evidence reveals that the adverse side effects and prolonged use can cause harm. This knowledge highlights the importance behind standardizing the approach to reduce pain and manage sedation by creating a balance utilizing nonpharmacologic and pharmacologic therapy to reduce exposure.|Sample/Setting: This setting took place at a 44-bed level 4 and 54-bed level 3 NICU at two Children’s hospitals in the major metropolitan area in Minnesota. The sample included 257 intubated neonates who were born less than 28 weeks’ gestation, 239 prior to and 18 following implementation.|Methods: A retrospective data collection from January of 2019 to June of 2021 was compared to the post-implementation group from November of 2021 to January 1st, 2022.|Results: The average use of morphine decreased by 67%. Fentanyl use decreased by 85%. Versed decreased by 97%. Ativan usage dropped by 88%. No neonates in the post-implementation group received methadone or dexmedetomidine. Average number of ventilator days decreased from 28 to 10.|Conclusion: Implementing standardized guidelines utilizing both nonpharmacologic and pharmacologic therapy in neonates less than 28 weeks’ gestation can be effective in managing pain while minimizing exposure to opioids, benzodiazepines, and dexmedetomidine.