Abstract
A mid-western surgical NICU identified the high frequency of postoperative pain in their patient population and sought to target this problem via a QI project. Based on findings from the literature review, two practice changes were implemented: a pain management discussion during the bedside postoperative handoff between surgery and NICU teams, and documentation of the analgesia plan in the postoperative and daily progress notes. Retrospective chart review evaluated the first 48-postoperative hours of all NICU patient surgeries that occurred during a six-month period; QI practice changes were implemented at the midpoint. Comparison between the pre-implementation and post-implementation surgeries demonstrated a net decrease in average and peak N-PASS scores by 14.4% and 7.2%, respectively. In the post-intervention group, 34 huddles were completed, analgesia plan documentation increased, cumulative intermittent opioid exposure decreased, opioid continuous infusion prescribing increased, and acetaminophen dosing increased. The initial results support continuation of QI practice changes. Future research should seek to evaluate the effect of the postoperative huddle and documentation on net postoperative opioid and non-opioid exposure, as well as the effect of opioid versus non-opioid exposure on N-PASS scores.