{"title":"The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study.","authors":"Bonnie Stevens, Mariana Bueno, Melanie Barwick, Marsha Campbell-Yeo, Christine Chambers, Carole Estabrooks, Rachel Flynn, Sharyn Gibbins, Denise Harrison, Wanrudee Isaranuwatchai, Sylvie LeMay, Melanie Noel, Jennifer Stinson, Anne Synnes, Charles Victor, Janet Yamada","doi":"10.1097/j.pain.0000000000003496","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>Implementation of infant pain practice change (ImPaC) is a multifaceted web-based resource to support pain practice change in neonatal intensive care unit (NICU). We evaluated the (1) intervention effectiveness and (2) implementation effectiveness of ImPaC using a hybrid type 1 effectiveness-implementation study (ie, cluster randomized controlled trial and longitudinal descriptive study). Eligible level 2 and 3 Canadian NICUs were randomized to intervention (INT) or waitlisted to usual care (UC) for 6 months. We assessed the number of painful procedures, proportion of procedures accompanied by valid assessment and evidence-based treatment, and pain intensity to determine intervention effectiveness using intention-to-treat (ITT) and wait-list (WL) analyses. Implementation feasibility and fidelity were explored. Twenty-three NICUs participated (12 INT, 11 UC). Thirty infants/NICU were included in the ITT (INT = 354, UC = 325) and the WL (INT = 678, UC = 325) analyses. In the ITT analysis, the average number of painful procedures/infant/day was lower in the INT group [2.62 (±3.47) vs 3.85 (±4.13), P < 0.001] than in the UC group. Pain assessment was greater in the INT group (34.7% vs 25.5%, P < 0.001) and pain intensity scores were lower [1.47 (1.25) vs 1.86 (1.97); P = 0.029]. Similarly, in the WL analysis, there were fewer painful procedures/infant/day [3.11 (±3.98) vs 3.85 (±4.13), P = 0.003] and increased pain assessment (30.4% vs 25.5%, P = 0.0001) and treatment (31.2% vs 24.0%, P < 0.001) in the INT group. Feasibility and implementation fidelity were associated with improved clinical outcomes.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PAIN®","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/j.pain.0000000000003496","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
摘要：婴儿疼痛实践改变的实施（ImPaC）是一种基于网络的多方面资源，用于支持新生儿重症监护室（NICU）疼痛实践的改变。我们采用第一类效果-实施混合研究（即分组随机对照试验和纵向描述性研究）评估了 ImPaC 的（1）干预效果和（2）实施效果。符合条件的加拿大 2 级和 3 级新生儿重症监护室被随机分配接受干预（INT）或常规护理（UC），为期 6 个月。我们通过意向治疗（ITT）和候补名单（WL）分析，评估了疼痛手术的数量、伴有有效评估和循证治疗的手术比例以及疼痛强度，以确定干预效果。同时还探讨了实施的可行性和忠实性。23 家新生儿重症监护室参与了此次研究（12 家 INT，11 家 UC）。在 ITT（INT = 354，UC = 325）和 WL（INT = 678，UC = 325）分析中，每个新生儿重症监护室均纳入了 30 名婴儿。在 ITT 分析中，INT 组患者/住院患者/天的平均疼痛治疗次数低于 UC 组 [2.62 (±3.47) vs 3.85 (±4.13)，P <0.001]。INT 组的疼痛评估率更高（34.7% vs 25.5%，P < 0.001），疼痛强度评分更低 [1.47 (1.25) vs 1.86 (1.97)；P = 0.029]。同样，在 WL 分析中，INT 组的疼痛程序/住院患者/天数减少 [3.11 (±3.98) vs 3.85 (±4.13), P = 0.003]，疼痛评估（30.4% vs 25.5%，P = 0.0001）和治疗（31.2% vs 24.0%，P < 0.001）增加。可行性和实施忠诚度与临床结果的改善相关。
The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study.
Abstract: Implementation of infant pain practice change (ImPaC) is a multifaceted web-based resource to support pain practice change in neonatal intensive care unit (NICU). We evaluated the (1) intervention effectiveness and (2) implementation effectiveness of ImPaC using a hybrid type 1 effectiveness-implementation study (ie, cluster randomized controlled trial and longitudinal descriptive study). Eligible level 2 and 3 Canadian NICUs were randomized to intervention (INT) or waitlisted to usual care (UC) for 6 months. We assessed the number of painful procedures, proportion of procedures accompanied by valid assessment and evidence-based treatment, and pain intensity to determine intervention effectiveness using intention-to-treat (ITT) and wait-list (WL) analyses. Implementation feasibility and fidelity were explored. Twenty-three NICUs participated (12 INT, 11 UC). Thirty infants/NICU were included in the ITT (INT = 354, UC = 325) and the WL (INT = 678, UC = 325) analyses. In the ITT analysis, the average number of painful procedures/infant/day was lower in the INT group [2.62 (±3.47) vs 3.85 (±4.13), P < 0.001] than in the UC group. Pain assessment was greater in the INT group (34.7% vs 25.5%, P < 0.001) and pain intensity scores were lower [1.47 (1.25) vs 1.86 (1.97); P = 0.029]. Similarly, in the WL analysis, there were fewer painful procedures/infant/day [3.11 (±3.98) vs 3.85 (±4.13), P = 0.003] and increased pain assessment (30.4% vs 25.5%, P = 0.0001) and treatment (31.2% vs 24.0%, P < 0.001) in the INT group. Feasibility and implementation fidelity were associated with improved clinical outcomes.
期刊介绍：
PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
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