Nursing Component Task
Nursing procedures & clinical learning

Pain Management (PM)

MANAGEMENT OF PAIN IN NEONATES

This is the process of managing pain in neonates using both pharmacological (multi-modal) and non-pharmacological (distraction, music) strategies to improve their quality of life.

Purpose

  • Assess pain in neonates
  • Manage pain using various strategies (pharmacological and non-pharmacological)
  • Prevent poor pain tolerance in adulthood
  • Prevent complications
  • Promote comfort
  • Prevent pain from bedside invasive procedures

Indications

  • Pharmacological
  • Non-pharmacological

Equipment

  • Patient’s folder (electronic or manual)
  • Pain assessment tools: (Premature Infant Pain Profile, Oucher Scale, Wong-Baker FACES Pain Rating Scale, Face Legs Activity Cry Consolability, Neonatal Infant Pain Scale, Parent Post-operative Pain Measure)
  • Medication tray
  • Weighing scale
  • Pain management strategies (medications, Sucrose, pain patch, balloons, pictures, videos)
  • Vital signs tray
  • A tray containing the following
  • Patient Treatment chart (Electronic or Manual)
  • Disposable spoon/rubber spoon
  • A cup
  • A saucer
  • A pair of scissors
  • Tissue paper/napkin
  • Syringes and needles
  • IV set (when necessary)
  • Cotton wool swabs
  • Receiver
  • Sharps box
  • Prescribed pain management strategies (medications, Sucrose, cold compress, pain patch)

Procedure steps

  • Introduce yourself and explain procedure to parent/guardian
  • Use language that parent/guardian understands and can express themselves
  • Educate parent/guardian on how to support
  • Prepare requirements and take to bed side
  • Practice five moments of hand hygiene
  • Assess pain using Precipitating factors, quality, radiation, severity, time (PQRST)
  • Use the age-specific pain scale (Premature Infant Pain Profile, Oucher Scale, Wong-Baker FACES Pain Rating Scale, Face Legs Activity Cry Consolability, Neonatal Infant Pain Scale, Parent Post-operative Pain Measure)
  • Make neonate comfortable when assessing pain
  • Check contraindications of pain medication (age, co-morbidities, route of administration)
  • Check baseline vital signs when necessary, before administration of medication
  • Check weight of neonate to calculate the dosage of medication
  • Provide appropriate pain medication as prescribed (Acetaminophen, NSAIDS, Opioids)
  • Administer medication through the appropriate route (topical, oral, parenteral, intra thecal)
  • Use non-pharmacological strategies that can distract the neonate (distraction, music)
  • Prepare pain chart to monitor progress of pain management
  • Identify non-pain symptoms that can affect the severity of the pain (fatigue, drowsiness, dypsnoea)
  • Observe the therapeutic effect of the medication administered
  • Educate parent/guardian to report any adverse reactions after administration of medication
  • Monitor vital signs especially respiration if medication includes opioids
  • Reassess pain to check changes in pain intensity, medication and behaviour of neonate
  • Congratulate and thank neonate, parent/guardian
  • Protect the painful site by repositioning, protective handling. reduce pressure from beddings
  • Nurse neonate in a calm environment
  • Dispose off, decontaminate equipment, and clean items
  • Document findings and report on the pain management strategy used and the effect (manual/electronic)

Precautions

  • Pain assessment is part of vital signs
  • Provide patient and family with adequate information and education on pain management
  • Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
  • Treat each patient as an individual and involve the patient and family in the pain management
  • Employ evidence-based contemporary recommendations for pain management such as:
  • Pre-emptive analgesia (analgesic given before a painful stimulus)
  • Multi-modal analgesia (using two or more forms of analgesic concurrently)
  • Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
  • Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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