To prevent or decrease neonatal pain associated with repetitive minor painful procedures using the nutraceutical, sucrose, in the Newborn Center.

To determine the receptiveness of nursing staff to evidence based practice changes through performance improvement methodology. 

Sample:Level II Neonatal Patients 32 weeks gestation or greater and Registered Nursing Staff comprised the sample.
 

Method:

Fifteen preterm (37 weeks or less) and 13 term infants (38 weeks or more) before sucrose implementation were compared with 50 preterm and 17 term infants after sucrose implementation using the premature infant pain profile (PIPP), CRIES Pain Scale, and heart rate to evaluate clinical indicators of pain. Baseline heart rate, oxygen saturation, pain scores were collected before touch or disturbance of infants. Post-implementation infants received 3 sucrose doses according to age at 2 minutes prior to heel-stick, right before heel lance, then after bandaid placement. Vitals signs and pain scores were collected again after heel-stick and then again after infants were swaddled for final data collection. Adverse reactions to sucrose were to be documented (e.g. choking, coughing, apnea, bradycardia) and immediate intervention provided by RN staff at bedside or practitioner/physician as needed. Staff nurses were involved in all aspects of data gathering, staff education and implementation of the sucrose program. 

Nursing staff was surveyed to determine their perceptions on use of sucrose and research in clinical setting. Secretaries randomly placed surveys in every other mailbox.

Surveys were on scantron forms with attachment for comments with no names or identifiers and return was anonymous to educator boxes in the unit. Results were analyzed by scantron reading device independently by the Center for Clinical Training and Development 

Results:

Heart Rates were higher during heel-stick and did not return to baseline in the post-stick period for both term and preterm infants without sucrose. Pain scores rose into pain levels for both preterm and term infants not receiving sucrose and did not fall to baseline in the post-evaluation period. Surveyed staff was satisfied or very satisfied with this application of research for improving pain management (91 %, n = 129). Staff were satisfied or very satisfied with analgesic effects of sucrose 92 %, n = 129). Staff would like to use more research-based interventions at the bedside in the future (96.9 %, n = 127).  

Conclusions:

Research evidence was feasible in the hospital setting and produced similar clinical results. Through participation and seeing with their own eyes what is stated in the evidence, procedural analgesia was embraced by nursing staff and more easily maintained in everyday practice.  

Implications:

Performance improvement methodology provides a mechanism by which nurses can become involved in practice change and see for themselves the clinical benefits as in this example. Nurses are more likely to accept practice changes where they not only hear about the evidence but also observe it clinically in the natural setting and actively participate in evaluation and implementation.