Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments. (29th April 2023)

• Record Type: Journal Article
• Authors: Benbrook, Keri; Manworren, Renee C. B.; Zuravel, Rebecca; Entler, Ashley; Riendeau, Kimberly; Myler, Catherine; Ricca, Paige
• Is Part Of: Advances in neonatal care. Volume 23:Number 2(2023)
• Page Start: 173
• Page End: 181
• Publication Date: 2023-04-29
• Subjects: chronically ventilated infants -- medically complex -- neonatal nursing -- neonatal pain -- NICU -- NIPS -- N-PASS -- sedation; Newborn infants -- Medical care -- Periodicals; Newborn infants -- Diseases -- Nursing -- Periodicals; Premature infants -- Hospital care -- Periodicals; 618.9201
• DOI: 10.1097/ANC.0000000000000968
• Languages: English
• ISSNs: 1536-0903

Abstract

Abstract : Background: Objective assessment tools should standardize and reflect nurses' expert assessments. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and the Neonatal Infant Pain Scale (NIPS) are valid measures of pain. The N-PASS also provides a sedation subscale. Purpose: The objective of this study was to determine N-PASS clinical validity and utility by evaluating agreement of N-PASS scores with bedside nurses' assessments of pain/agitation and sedation in a 64-bed tertiary neonatal intensive care unit. Methods: Fifteen bedside nurses trained to use the N-PASS and the NIPS prospectively completed 202 pain/agitation and sedation assessments from a convenience sample of 88 infants, including chronically ventilated, medically fragile infants. N-PASS and NIPS scores were obtained simultaneously but independently of nurse investigators. Bedside nurses also made recommendations about infants' pain and sedation management. Results: There was moderate agreement between N-PASS pain scores and nurses' recommendations (κ= 0.52), very strong agreement between N-PASS sedation scores and nurses' recommendations (κ= 0.99), and very strong associations between N-PASS pain and NIPS scores ( P < .001). Bedside nurse and independent investigator interrater reliability was good for N-PASS pain and NIPS scores (intraclass correlation coefficient [ICC] = 0.83, ICC = 0.85) and excellent for N-PASS sedation (ICC = 0.94). During 93% of assessments, bedside nurses reported that the N-PASS reflected the level of infant sedation well or very well. Implications for Practice and Research: The N-PASS provides an easy-to-use, valid, and reliable objective measure of pain and sedation that reflects nurses' assessments. Additional studies using the N-PASS are needed to verify results and the influence of the N-PASS on pain and sedation management for medically fragile infants with chronic medical conditions.