Reducing pain from heel lances in neonates following education on oral sucrose

Mark Shen, Gladys El-Chaar

Background Heel lances are common painful procedures performed in the neonatal intensive care unit (NICU). Upon observation, pain relieving methods were not consistently applied during such procedures in our institution. Objective The objective of this three-phase quality improvement project was to improve pain management for heel lance-induced pain in the NICU. Setting This study took place in a 27-bed NICU in a level IV perinatal regional center at a 591 bed university affiliated teaching hospital in New York, United States. Method Study Phase 1, involving 25 neonates, documented baseline pain management strategies and pain scores, which were measured before, during, and after heel lancing using the Neonatal Pain Agitation and Sedation Scale (N-PASS). In Study Phase 2, nurses and physicians were educated on the use of sucrose and non-pharmacological measures to prevent and manage heel lance-induced pain. Study Phase 3 (Post education evaluation), had the same procedure as Study Phase 1, and involved another host of 25 neonates. Main outcome measure Pain scores were compared in groups of neonates in Phase 1 (before education) and Phase 3 (after education) before, during and after heel lancing. Other outcome measures included quantifying the use of sucrose and documenting any adverse effects. Results We found an 84 % increase in the use of sucrose post-education (Phase 3), and most importantly, an 11.2 % reduction in pain scores from heel lances in neonates. Four neonates who did not receive sucrose in Phase 3 had higher pain scores during heel lancing than those who did (3.5 and 2.38, respectively). There were no adverse effects reported with sucrose. Conclusion Health care providers were aware of sucrose but were not using this treatment modality, despite its availability on nursing units. Education was effective in the adoption of sucrose use, leading to a reduction in pain from heel lances in neonates.