Shabih Manzar, MD and Nitin Walyat, MD

Abstract

Introduction:

Fentanyl has been associated with a higher incidence of cerebellar injury and lower cerebellar diameter in preterm infants. We noticed an increased use of fentanyl among extremely low birth weight (ELBW) infants (birth weight < 1000 grams) in our NICU. To reduce its use by 20%, we launched this quality improvement (QI) project.

Methods:

The potential factors involved in fentanyl use were noted down. A driver diagram was created, and areas of improvement were recognized (Figure). A 20% improvement was calculated as:14 (baseline use) – 11(expected use) ÷ 14. The QI team met and discussed the plan. The information was disseminated to all NICU nursing staff via group email and handouts. The results were analyzed for the number of doses used in the following two months.

Results:

In the following sixty days, there were seven ELBW infants. The mean gestation age was 27 weeks (range 24 to 31) with the mean birth weight of 818 grams (range 580 to 990grams). One infant received 9 days of continuous drip (infant developed gram-negative septic shock- we eliminated the infant from the analysis). Out of 6 infants, four (67%) received no fentanyl. One infant received one dose while the other received two doses.

Conclusion:

Our preliminary data suggested that non-pharmacological management of pain and agitation with strict medication guidelines resulted in a reduction in fentanyl use. We expect other units to adopt our policy. A larger pool of infants will enhance and further validate our findings.

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References:

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Disclosure: The authors do not identify any relevant disclosures.

Acknowledgments: Dr. Manzar would like to thank all the members of the NICU staff at LSU Health for their cooperation in the QI project.