The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study

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

The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study

Pain. 2024 Dec 6. doi: 10.1097/j.pain.0000000000003496. Online ahead of print.

Authors

Bonnie Stevens^{1

2}, Mariana Bueno³, Melanie Barwick^{1

4}, Marsha Campbell-Yeo^{5

6}, Christine Chambers^{6

7}, Carole Estabrooks⁸, Rachel Flynn⁹, Sharyn Gibbins¹⁰, Denise Harrison^{11

12

13}, Wanrudee Isaranuwatchai¹⁴, Sylvie LeMay¹⁵, Melanie Noel¹⁶, Jennifer Stinson¹⁷, Anne Synnes^{18

19}, Charles Victor²⁰, Janet Yamada²¹

Affiliations

¹ The Hospital for Sick Children, Research Institute, Child Health and Evaluative Sciences, Toronto, ON, Canada.
² Lawrence S. Bloomberg Faculty of Nursing & Faculties of Medicine and Dentistry, University of Toronto, Toronto, ON, Canada.
³ Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
⁴ Faculty of Medicine, Psychiatry, Dalla Lana School of Public Health and IHPME, University of Toronto, Toronto, ON, Canada.
⁵ School of Nursing, Faculty of Health, and Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada.
⁶ IWK Health Centre, Centre for Pediatric Pain Research, Halifax, NS, Canada.
⁷ Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁸ Faculty of Nursing, Edmonton Health Clinic Academy, University of Alberta, Edmonton, AB, Canada.
⁹ School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
¹⁰ Trillium Health Partners, Professional Practice, Mississauga, ON, Canada.
¹¹ Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
¹² Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹³ Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada.
¹⁵ Faculty of Nursing, and Researcher, CHU Sainte-Justine Research Center, TransMedTech Institute and Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, QC, Canada.
¹⁶ Department of Psychology, University of Calgary, Calgary, AB, Canada.
¹⁷ Child Health Evaluative Sciences, The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.
¹⁸ Division of Neonatology, BC Children's Hospital Research Institute, BC Women's Hospital, Vancouver, Canada.
¹⁹ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
²⁰ The Institute of Health Policy, Management and Evaluation, University of Toronto, Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
²¹ Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada.

PMID: 39679622
DOI: 10.1097/j.pain.0000000000003496

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.

Trial registration: ClinicalTrials.gov NCT03825822.

Associated data

ClinicalTrials.gov/NCT03825822

Grants and funding

FDN-148452/CIHR