Implementation and case-study results of potentially better practices to improve pain management of neonates.

OBJECTIVE: Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process. METHODS: Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These centers developed and implemented evidence-based potentially better practices for pain management and sedation in neonates. The group introduced changes through plan-do-study-act cycles and tracked performance measures throughout the process. RESULTS: Strategies for implementing potentially better practices varied between centers on the basis of local characteristics. Individual centers identified barriers to implementation, developed tools for improvement, and shared their experience with the collaborative. Baseline data from the 12 sites revealed substantial opportunities for improved pain management, and local potentially better practice implementation resulted in measurable improvements in pain management at participating centers. CONCLUSIONS: The use of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices at participating centers.

Case report of a pressure ulcer in an infant receiving extracorporeal life support: the use of a novel mattress surface for pressure reduction.

This case report describes a 4350-gram male infant of 38 weeks gestation who was placed on extracorporeal life support. On day 4 of life, a large bilateral ecchymotic area involving the scapula and extending to the mid sacral-lumbar-thoracic area was noted, placing the infant at significant risk for pressure ulcer formation. The infant's initial presentation, evaluation, treatment, and response to therapy are discussed. A review of the anatomy and physiology of neonatal skin and the etiology of pressure ulcers is described. The incidence and staging of pressure ulcers is outlined, and high-risk infants and skin zones are identified. Skin care challenges in the patient on extracorporeal life support (ECLS) are outlined, and strategies to assess and treat affected areas are offered. The use of a novel mattress surface for global pressure reduction in the infant undergoing ECLS therapy is discussed.