AAP: A Multicenter Collaborative to Improve Postoperative Pain Management in the NICU

A Multicenter Collaborative to Improve Postoperative Pain Management in the NICU


This quality improvement initiative aimed to decrease unrelieved postoperative pain and improve family satisfaction with pain management.


NICUs within the Children’s Hospitals Neonatal Consortium that care for infants with complex surgical problems participated in this collaborative. Each of these centers formed multidisciplinary teams to develop aims, interventions, and measurement strategies to test in multiple Plan-Do-Study-Act cycles. Centers were encouraged to adopt evidence-based interventions from the Clinical Practice Recommendations, which included pain assessment tools, pain score documentation, nonpharmacologic treatment measures, pain management guidelines, communication of a pain treatment plan, routine discussion of pain scores during team rounds, and parental involvement in pain management. Teams submitted data on a minimum of 10 surgeries per month, spanning from January to July 2019 (baseline), August 2019 to June 2021 (improvement work period), and July 2021 to December 2021 (sustain period).


The percentage of patients with unrelieved pain in the 24-hour postoperative period decreased by 35% from 19.5% to 12.6%. Family satisfaction with pain management measured on a 3-point Likert scale with positive responses ≥2 increased from 93% to 96%. Compliance with appropriate pain assessment and numeric documentation of postoperative pain scores according to local NICU policy increased from 53% to 66%. The balancing measure of the percentage of patients with any consecutive sedation scores showed a decrease from 20.8% at baseline to 13.3%. All improvements were maintained during the sustain period.


Standardization of pain management and workflow in the postoperative period across disciplines can improve pain control in infants.


neonatal intensive care unitsnewbornpainpain managementpain measurementpain scorepostoperative analgesiapostoperative painsedation procedurelikert scale