351: Implementing an Online Practice-Change Resource to Sustain Improvements in Neonatal Pain Outcomes

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Digital Health Technologies , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: The Implementation of Infant Pain Practice Change (ImPaC) Resource is an evidence-based, interactive online platform. ImPaC is designed to guide healthcare champions through multistep practice change cycles to improve pain assessment and nonpharmacological pain (NP) management practices in Neonatal Intensive Care Units (NICUs). In a hybrid type 1 effectiveness-implementation study, NICUs were asked to complete at least 1 change cycle; both clinical(1) and implementation(2) effectiveness were demonstrated after 6-months exposure to ImPaC. We evaluated the sustainability of improved clinical outcomes for an additional 12 months in relation to fewer versus greater numbers of completed ImPaC cycles.

Methods: Teams of 3-6 healthcare champions, recruited from each eligible Canadian NICU (>15 beds), were invited to continue using ImPaC for up to 12 months following the initial study exposure period. Clinical outcome data on the number of painful procedures, and proportion of pain assessment and NP management strategies accompanying painful procedures were collected from 30 infants’ charts/NICU 6 and 12 months later. Website analytics confirmed the number of ImPaC cycles completed. Clinical outcome data were analyzed by comparing NICUs that completed <1 cycle with those that completed ≥1 cycle, using generalized estimating equations models to account for within-unit correlation.

Results: 5/23 NICUs completed <1 ImPaC cycle; 7 completed one only; 9 completed two only; 1 completed three only; and 1 completed four. Compared to NICUs completing <1 cycle, those completing ≥1 and ≥2 cycles had significantly (p<0.001) fewer painful procedures/infant/day (4.37 vs 2.69, 2.41), and more pain assessment (11% vs 43%, 42%) and NP management strategies (17% vs 35%, 40%) at 6 months, and more pain assessment (22% vs 46%, 37%) at 12 months. Units completing ≥3 cycles sustained more pain assessment (22% vs 48%) and NP management strategies (29% vs 45%) at 12 months (p<0.001).

Conclusions: When compared to NICUs completing <1 ImPaC cycle, NICUs completing 1-4 cycles sustained improvement in the number of painful procedures, and proportion of pain assessment and NP management strategies 6 months after the initial ImPaC exposure period. At 12 months, NICUs completing 1-4 cycles maintained improved pain assessment, while only NICUs completing 3 or 4 cycles sustained better NP management strategies. Continued implementation of ImPaC, which is based on implementation science and quality improvement principles, is needed to support the sustainability of improved clinical pain practices. More knowledge of factors influencing ImPaC cycle completion in local contexts is warranted.

References: (1) Stevens B, Bueno M, Barwick M, et al. The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study. Pain 166(7):1587-1596, July 2025. https://doi: 10.1097/j.pain.0000000000003496

(2) Bueno M, Pearson K, Barwick MA, et al. Enhancing infant pain assessment and treatment: investigating barriers, facilitators, and implementation outcomes with the ImPaC Resource. Implement Sci Commun (2026). https://doi.org/10.1186/s43058-026-00856-8

Presenting Author: Bonnie Stevens
Submitting Author: Bonnie Stevens

Senior Author: Bonnie Stevens

IASP 2026 Global Year theme of Neuropathic Pain: No

• Bonnie Stevens: RN, PhD, FAAN, FCAHS - The Hospital for Sick Children
• Shirine Riahi: RN, MN - The Hospital for Sick Children
• Charles Victor: BSc, MSc - University of Toronto
• Melanie Barwick: PhD, CPsych - The Hospital for Sick Children
• Mariana Bueno: RN, PhD - University of Toronto
• Marsha Campbell-Yeo: RN, NNP-BC, PhD - Dalhousie University
• Christine Chambers: BSc, MA, PhD - Dalhousie University
• Carole Estabrooks: BN, MN, PhD - University of Alberta
• Rachel Flynn: RN, PhD - University College Cork
• Sharyn Gibbins: RN-EC, MS, PhD - Trillium Health Partners
• Denise Harrison: RN, PhD - University of Melbourne
• Wanrudee Isaranuwatchai: BSc, PhD - Health Intervention and Technology Assessment Program (HITAP) Foundation (Thailand)
• Sylvie Le May: RN, PhD, FCAN - Université de Montréal
• Melanie Noel: PhD, RPsych - University of Calgary
• Jennifer Stinson: RN-EC, PhD, CPNP, FAAN - The Hospital for Sick Children
• Anne Synnes: MHSc, MDCM, FRCPC - University of British Columbia
• Janet Yamada: RN, PhD - Toronto Metropolitan University