Mission Possible – Prioritize Pain Prevention

Professor Bonnie Stevens, Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada b.stevens@utoronto.ca

We hbabyskintoskinave heard repeatedly about the high numbers of painful procedures undertaken with hospitalized neonates and their potential consequences. We are also aware of insufficient practices to treat the pain associated with these procedures. This inadequacy is often attributed to lack of knowledge of care providers, when really it is a lack of organizational commitment to decreasing pain and changing behavior.

I have devoted my research career to studying pain in infants. However, even with 50 infant  pain measures and multiple systematic reviews synthesizing pain-DadSSCrelief strategies for health care professionals (e.g. sucrose [1]) and parents (e.g. skin-to-skin care and breastfeeding), effectively implementing these strategies remains challenging. Therefore, I have refocused my research within implementation science to determine how healthcare organizations can effectively change practice and influence practice, research and policy agendas.

I believe that evidence or champions alone cannot change behavior or outcomes. Institutions need to prioritize pain prevention and demonstrate their commitment at the point of care. They can facilitate dialogue amongst health care providers, support leaders and the efforts of local champions, and provide resources. Without organizational support for pain relief, the best evidence and individual efforts will go unnoticed.I have completed a large national study, funded through the Canadian Institutes of Health Research, where with strong leadership, committed resources and local champions, hospital units improved pain assessment and treatment and decreased procedural pain in children [2,3]. However, this approach, which supported an on-site research nurse was not feasible or sustainable [4].

We have now developed a multiplatform web-based infant pain resource that we will implement and evaluate. The resource consists of a 7-step evidence-based quality improvement strategy for changing behavior and enhancing outcomes. Initial evaluation indicates that health care professionals are highly satisfied and excited about this resource. It is my hope that this strategy will stop the conversation on inadequate procedural pain management and start the dialogue on successful change management.

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)


  1. B. Stevens, J. Yamada, A. Ohlsson, A. Shorkey, S. Haliburton. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3.
  2. B. Stevens, J. Yamada, S. Promislow, J. Stinson, D. Harrison and The CIHR Team in Children’s Pain. (2014). Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children. Implementation Science, 9, 120.
  3. B. Stevens, J. Yamada, C. Estabrooks, J. Stinson, F. Campbell, S.D. Scott, G. Cummings and CIHR Team in Children’s Pain. (2013). Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 155(1):60-68.
  4. B. Stevens, J. Yamada, S. Promislow, M. Barwick, M. Pinard, CIHR Team in Children’s Pain. Sustainability of pediatric pain outcomes following a knowledge translation booster intervention. Pediatrics (In Press).