Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines
Objective: To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines. Study design: Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and perio...
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| Veröffentlicht in: | Journal of perinatology 2017-09, Vol.37 (9), p.1038-1042 |
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| container_title | Journal of perinatology |
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| creator | Rana, D Bellflower, B Sahni, J Kaplan, A J Owens, N T Arrindell, E L Talati, A J Dhanireddy, R |
| description | Objective:
To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines.
Study design:
Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014).
Results:
Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2,
P
= |
| doi_str_mv | 10.1038/jp.2017.88 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1910338881</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A689285280</galeid><sourcerecordid>A689285280</sourcerecordid><originalsourceid>FETCH-LOGICAL-c575t-b3f2e769d104cc9394f18c641352e6b7fe7710628209a5a1f31fd76840555cc03</originalsourceid><addsrcrecordid>eNqNkl2L1DAUhoMo7jh64w-QgCCidMxnk14ugx8Li4K41yGTnsxmaNPatAv6602dVbu6LJKLhPM-5z3hnIPQU0o2lHD95tBvGKFqo_U9tKJClYWUgt9HK6IELzQX5Ql6lNKBkFlUD9EJ0yVVgrEV8p-hnhzUONrBdWNw2MYaJ6jtGK4AT2Nowvf87iIOEVv88Wx7ga0fYcCh7RtoIY5HufO4t5lpbbT7n3G8n0INTYiQHqMH3jYJnlzfa3Tx7u2X7Yfi_NP7s-3peeGkkmOx456BKquaEuFcxSvhqXaloFwyKHfKg1KUlEwzUllpqefU16rUgkgpnSN8jV4effuh-zpBGk0bkoOmsRG6KRla5Y5xrTXN6PO_0EM3DTH_zrCSSsk51eQuilZcZ4ow9ofa2wZMiL4bB-vm0ua01BXTki29bqEkEYJonQe2RptbqHxqaIPrIviQ4zds_ythWeHFIuESbDNepq6Z5jGmm853gkvHV0fQDV1KA3jTD6G1wzdDiZl31Bx6M--o0TrDz65bOu1aqH-jv5YyA6-PQMpS3MOw6Pm_dj8As93o2Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1938533022</pqid></control><display><type>article</type><title>Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Rana, D ; Bellflower, B ; Sahni, J ; Kaplan, A J ; Owens, N T ; Arrindell, E L ; Talati, A J ; Dhanireddy, R</creator><creatorcontrib>Rana, D ; Bellflower, B ; Sahni, J ; Kaplan, A J ; Owens, N T ; Arrindell, E L ; Talati, A J ; Dhanireddy, R</creatorcontrib><description>Objective:
To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines.
Study design:
Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014).
Results:
Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2,
P
=<0.001. Cumulative dose exposure decreased, opioids in morphine equivalent dose, mg kg
−1
(1.64 (0.38 to 6.94) vs 0.51 (0.04 to 2.33),
P
=0.002), sedatives in midazolam equivalent, mg kg
−1
(0.16 (0.03 to 7.39) vs 0.10 (0.00 to 4.00),
P
=0.03). Ten patients required treatment for iatrogenic opioid withdrawal versus only three in post guideline,
P
=0.02.
Conclusions:
Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.</description><identifier>ISSN: 0743-8346</identifier><identifier>EISSN: 1476-5543</identifier><identifier>DOI: 10.1038/jp.2017.88</identifier><identifier>PMID: 28617422</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>692/499 ; 692/700/1720 ; 692/700/784 ; Analgesics, Opioid - administration & dosage ; Anesthesia ; Benzodiazepines ; Benzodiazepines - administration & dosage ; Birth weight ; Care and treatment ; Complications and side effects ; Dosage and administration ; Equivalence ; Exposure ; Female ; Gestational Age ; Guidelines ; Humans ; Hypnotics ; Hypnotics and Sedatives - administration & dosage ; Hypoxia ; Infant, Newborn ; Infants ; Intensive care ; Intensive Care Units, Neonatal - statistics & numerical data ; Laws, regulations and rules ; Male ; Mechanical ventilation ; Medicine ; Medicine & Public Health ; Methadone ; Methods ; Midazolam ; Morphine ; Narcotics ; Neonatal care ; Neonatal intensive care ; Neonatal intensive care units ; Opioids ; original-article ; Pain ; Pain management ; Pain Management - methods ; Pain Measurement - methods ; Patients ; Pediatric research ; Pediatric Surgery ; Pediatrics ; Practice Guidelines as Topic ; Respiration, Artificial ; Respiratory failure ; Respiratory Insufficiency - therapy ; Retrospective Studies ; Sedatives ; Surgery ; Ventilation</subject><ispartof>Journal of perinatology, 2017-09, Vol.37 (9), p.1038-1042</ispartof><rights>Nature America, Inc., part of Springer Nature. 2017</rights><rights>COPYRIGHT 2017 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Sep 2017</rights><rights>Nature America, Inc., part of Springer Nature. 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c575t-b3f2e769d104cc9394f18c641352e6b7fe7710628209a5a1f31fd76840555cc03</citedby><cites>FETCH-LOGICAL-c575t-b3f2e769d104cc9394f18c641352e6b7fe7710628209a5a1f31fd76840555cc03</cites><orcidid>0000-0002-8787-6499 ; 0000-0002-3720-9495</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/jp.2017.88$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/jp.2017.88$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28617422$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rana, D</creatorcontrib><creatorcontrib>Bellflower, B</creatorcontrib><creatorcontrib>Sahni, J</creatorcontrib><creatorcontrib>Kaplan, A J</creatorcontrib><creatorcontrib>Owens, N T</creatorcontrib><creatorcontrib>Arrindell, E L</creatorcontrib><creatorcontrib>Talati, A J</creatorcontrib><creatorcontrib>Dhanireddy, R</creatorcontrib><title>Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines</title><title>Journal of perinatology</title><addtitle>J Perinatol</addtitle><addtitle>J Perinatol</addtitle><description>Objective:
To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines.
Study design:
Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014).
Results:
Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2,
P
=<0.001. Cumulative dose exposure decreased, opioids in morphine equivalent dose, mg kg
−1
(1.64 (0.38 to 6.94) vs 0.51 (0.04 to 2.33),
P
=0.002), sedatives in midazolam equivalent, mg kg
−1
(0.16 (0.03 to 7.39) vs 0.10 (0.00 to 4.00),
P
=0.03). Ten patients required treatment for iatrogenic opioid withdrawal versus only three in post guideline,
P
=0.02.
Conclusions:
Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.</description><subject>692/499</subject><subject>692/700/1720</subject><subject>692/700/784</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Anesthesia</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - administration & dosage</subject><subject>Birth weight</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Dosage and administration</subject><subject>Equivalence</subject><subject>Exposure</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Guidelines</subject><subject>Humans</subject><subject>Hypnotics</subject><subject>Hypnotics and Sedatives - administration & dosage</subject><subject>Hypoxia</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Intensive care</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Laws, regulations and rules</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methadone</subject><subject>Methods</subject><subject>Midazolam</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Neonatal care</subject><subject>Neonatal intensive care</subject><subject>Neonatal intensive care units</subject><subject>Opioids</subject><subject>original-article</subject><subject>Pain</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain Measurement - methods</subject><subject>Patients</subject><subject>Pediatric research</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Practice Guidelines as Topic</subject><subject>Respiration, Artificial</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Retrospective Studies</subject><subject>Sedatives</subject><subject>Surgery</subject><subject>Ventilation</subject><issn>0743-8346</issn><issn>1476-5543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkl2L1DAUhoMo7jh64w-QgCCidMxnk14ugx8Li4K41yGTnsxmaNPatAv6602dVbu6LJKLhPM-5z3hnIPQU0o2lHD95tBvGKFqo_U9tKJClYWUgt9HK6IELzQX5Ql6lNKBkFlUD9EJ0yVVgrEV8p-hnhzUONrBdWNw2MYaJ6jtGK4AT2Nowvf87iIOEVv88Wx7ga0fYcCh7RtoIY5HufO4t5lpbbT7n3G8n0INTYiQHqMH3jYJnlzfa3Tx7u2X7Yfi_NP7s-3peeGkkmOx456BKquaEuFcxSvhqXaloFwyKHfKg1KUlEwzUllpqefU16rUgkgpnSN8jV4effuh-zpBGk0bkoOmsRG6KRla5Y5xrTXN6PO_0EM3DTH_zrCSSsk51eQuilZcZ4ow9ofa2wZMiL4bB-vm0ua01BXTki29bqEkEYJonQe2RptbqHxqaIPrIviQ4zds_ythWeHFIuESbDNepq6Z5jGmm853gkvHV0fQDV1KA3jTD6G1wzdDiZl31Bx6M--o0TrDz65bOu1aqH-jv5YyA6-PQMpS3MOw6Pm_dj8As93o2Q</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Rana, D</creator><creator>Bellflower, B</creator><creator>Sahni, J</creator><creator>Kaplan, A J</creator><creator>Owens, N T</creator><creator>Arrindell, E L</creator><creator>Talati, A J</creator><creator>Dhanireddy, R</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7RV</scope><scope>7T5</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8787-6499</orcidid><orcidid>https://orcid.org/0000-0002-3720-9495</orcidid></search><sort><creationdate>20170901</creationdate><title>Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines</title><author>Rana, D ; Bellflower, B ; Sahni, J ; Kaplan, A J ; Owens, N T ; Arrindell, E L ; Talati, A J ; Dhanireddy, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c575t-b3f2e769d104cc9394f18c641352e6b7fe7710628209a5a1f31fd76840555cc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>692/499</topic><topic>692/700/1720</topic><topic>692/700/784</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Anesthesia</topic><topic>Benzodiazepines</topic><topic>Benzodiazepines - administration & dosage</topic><topic>Birth weight</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Dosage and administration</topic><topic>Equivalence</topic><topic>Exposure</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Guidelines</topic><topic>Humans</topic><topic>Hypnotics</topic><topic>Hypnotics and Sedatives - administration & dosage</topic><topic>Hypoxia</topic><topic>Infant, Newborn</topic><topic>Infants</topic><topic>Intensive care</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Laws, regulations and rules</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methadone</topic><topic>Methods</topic><topic>Midazolam</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Neonatal care</topic><topic>Neonatal intensive care</topic><topic>Neonatal intensive care units</topic><topic>Opioids</topic><topic>original-article</topic><topic>Pain</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain Measurement - methods</topic><topic>Patients</topic><topic>Pediatric research</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Practice Guidelines as Topic</topic><topic>Respiration, Artificial</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Retrospective Studies</topic><topic>Sedatives</topic><topic>Surgery</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rana, D</creatorcontrib><creatorcontrib>Bellflower, B</creatorcontrib><creatorcontrib>Sahni, J</creatorcontrib><creatorcontrib>Kaplan, A J</creatorcontrib><creatorcontrib>Owens, N T</creatorcontrib><creatorcontrib>Arrindell, E L</creatorcontrib><creatorcontrib>Talati, A J</creatorcontrib><creatorcontrib>Dhanireddy, R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of perinatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rana, D</au><au>Bellflower, B</au><au>Sahni, J</au><au>Kaplan, A J</au><au>Owens, N T</au><au>Arrindell, E L</au><au>Talati, A J</au><au>Dhanireddy, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines</atitle><jtitle>Journal of perinatology</jtitle><stitle>J Perinatol</stitle><addtitle>J Perinatol</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>37</volume><issue>9</issue><spage>1038</spage><epage>1042</epage><pages>1038-1042</pages><issn>0743-8346</issn><eissn>1476-5543</eissn><abstract>Objective:
To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines.
Study design:
Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014).
Results:
Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2,
P
=<0.001. Cumulative dose exposure decreased, opioids in morphine equivalent dose, mg kg
−1
(1.64 (0.38 to 6.94) vs 0.51 (0.04 to 2.33),
P
=0.002), sedatives in midazolam equivalent, mg kg
−1
(0.16 (0.03 to 7.39) vs 0.10 (0.00 to 4.00),
P
=0.03). Ten patients required treatment for iatrogenic opioid withdrawal versus only three in post guideline,
P
=0.02.
Conclusions:
Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>28617422</pmid><doi>10.1038/jp.2017.88</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-8787-6499</orcidid><orcidid>https://orcid.org/0000-0002-3720-9495</orcidid></addata></record> |
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| ispartof | Journal of perinatology, 2017-09, Vol.37 (9), p.1038-1042 |
| issn | 0743-8346 1476-5543 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | 692/499 692/700/1720 692/700/784 Analgesics, Opioid - administration & dosage Anesthesia Benzodiazepines Benzodiazepines - administration & dosage Birth weight Care and treatment Complications and side effects Dosage and administration Equivalence Exposure Female Gestational Age Guidelines Humans Hypnotics Hypnotics and Sedatives - administration & dosage Hypoxia Infant, Newborn Infants Intensive care Intensive Care Units, Neonatal - statistics & numerical data Laws, regulations and rules Male Mechanical ventilation Medicine Medicine & Public Health Methadone Methods Midazolam Morphine Narcotics Neonatal care Neonatal intensive care Neonatal intensive care units Opioids original-article Pain Pain management Pain Management - methods Pain Measurement - methods Patients Pediatric research Pediatric Surgery Pediatrics Practice Guidelines as Topic Respiration, Artificial Respiratory failure Respiratory Insufficiency - therapy Retrospective Studies Sedatives Surgery Ventilation |
| title | Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines |
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