36 Implementation processes in pain assessment in the NICU: an interactive “Meet the pain” tutorial

Introduction Adequate pain management is one of the key issues in neonatal intensive care units. However, pain assessment in non-verbal critically ill preterm neonates remains a daily challenge. Therefore, systematic education, implementation, and validation of better practices in pain assessment are essential. The aim of this study was a valid and reproducible pain assessment in the NICU as a step toward optimizing pain management and analgesia. Methodology Thirty-four NICU nurses were included in the interactive educational program "Meet the pain" running from December 2022 to March 2023 (32/23 S-IV Grant). The program was led by a healthcare team consisting of three neonatologists, two head nurses, and one research nurse. The nurses were tested in COMFORTneo and Numeric rating scale on the representative videos of preterm neonates admitted to the NICU (23 – 34 postmenstrual weeks). Inter-rater variability was validated by Cohen ?. Descriptive statistics were performed to reveal disagreements in individual items of the COMFORTneo scale. Results Testing of inter-rater variability demonstrated moderate agreement ?=0.44 in pain assessment at this stage of implementation. Based on the results, the COMFORTneo items with high-rate errors (alertness and body movement) were adjusted concerning extreme prematurity. Surprisingly, 8/34 raters made a formal/numerical error while completing the form. The educational re-training of nurses has been performed. Conclusion Systematic processes in pain assessment, identification of "weak spots" and education of caregivers are the key elements in the optimization of pain management in the NICU.