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

International Journal of Clinical Pharmacy volume 37, pages 529–536 (2015)Cite this article

Abstract

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.

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Acknowledgements

The authors wish to thank Margaret Murphy, MS, RNC, NNP and the NICU nurses for their assistance and supervision with the initial N-PASS scoring and other aspects of the study. Additionally, the authors would like to thank Melissa Fazzarri, PhD for her assistance with the statistical analysis and Kelly Winters for editorial assistance.

Funding

This quality improvement project received no funding from external sources.

Conflicts of interest

Neither author has conflicts of interest, relevant financial or personal relationships to disclose.

Author information

Affiliations

  1. Department of Pharmacy, Winthrop-University Hospital, 259 1st Street, Mineola, NY, 11501, USA

    Mark Shen & Gladys El-Chaar

  2. Department of Clinical Pharmacy Practice, St. John’s University College of Pharmacy and Health Sciences, Queens, NY, 11439, USA

    Gladys El-Chaar

Authors
  1. Mark Shen
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  2. Gladys El-Chaar
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Corresponding author

Correspondence to Mark Shen.

Appendix: sucrose proposed guide

Appendix: sucrose proposed guide

Indications:

Procedures of short duration that may potentially cause mild to moderate pain, such as heel lancing, venipuncture, arterial puncture.

Most effective for newborns and infants <6 months old.

Contraindications:

Necrotizing enterocolitis (NEC), nil per os (NPO).

Dose:

Sucrose 24 %, 0.05–0.5 mL (up to 2 mL/dose), 12–120 mg/dose.

Very low birth weight: Consider lower doses, 12–24 mg/dose.

Maximum number of doses/day: <10.

Administration:

Must be intraoral sucrose (administer on tongue).

No more than 2 min before start of painful procedure.

If possible, use with Non-nutritive sucking-improved efficacy.

Ventilated neonate: 1 drop at a time to tongue, as needed.

Potential ADRs:

Gagging, choking, oxygen desaturations.

Formulary availability:

Sucrose solutions (24 %).

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Shen, M., El-Chaar, G. Reducing pain from heel lances in neonates following education on oral sucrose. Int J Clin Pharm 37, 529–536 (2015). https://doi.org/10.1007/s11096-015-0090-7

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  • DOI: https://doi.org/10.1007/s11096-015-0090-7

Keywords

  • Education
  • Heel lance
  • Neonate
  • Newborn
  • Pain
  • Pharmacist
  • Sucrose