Nonpharmacological analgesic interventions among newborn infants in the University Hospital of the University of Sao Paulo: a best practice implementation project. Issue 4 (18th December 2020) - Brito, Ana P.A.
ABSTRACT: Introduction: Despite evidence from studies on nonpharmacological pain management among newborns, many health professionals still don't apply evidence from scientific knowledge in their clinical practice. Objectives: To promote evidence-based practice for nonpharmacological analgesic interventions among newborns in the Maternity Ward of the University Hospital of the University of Sao Paulo, improving pain management and promoting healthy newborn growth and development, and better use of resources. Method: The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice framework for promoting evidence-based healthcare involve three phases of activity: conducting a baseline audit, implementing strategies to address areas of noncompliance and conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice. Ten evidence-based criteria on nonpharmacological pain management among newborns were audited, by direct observation of the nursing staff activities involving single skin-breaking procedures in the newborn. Results: The baseline audit indicated poor compliance with evidence in current practice in most of the evidence-based criteria audited. Discussion with the implementation team identified barriers to best practice, with interventions including a nursing protocol and educational program for all nursing staff on nonpharmacological analgesic approaches to reduce pain in the newborn (breastfeeding, skin-to-skin contact with the mother, nonnutritive sucking and glucose 25%), and a leaflet to inform the best available evidence on newborn pain management. In the follow-up audit, compliance increased in eight of nine audit criteria, with criterion 7 remaining at 100% compliance to best practice. Conclusion: The current best practice implementation project contributed to establishing evidence-based practice and enhancing neonatal pain management during skin-breaking painful procedures in the University Hospital. However, to achieve 100% compliance with all the evidence-based audit criteria, we will need to invest in continuing education and extend this implementation project to other related settings of the hospital. Moreover, it is necessary to perform follow-up cyclical audits to assess compliance and address barriers to best practice, enhancing the quality of nursing care, ensuring better results on pain management of the newborn and ongoing sustainability of this project.