Implementing the Use of a Lullaby Device During Painful Procedures for Preterm Infants in the Neonatal Intensive Care Unit: An Evidence-Based Practice Improvement Project

BACKGROUND: According to research findings, pain in hospitalized preterm infants is not being adequately controlled during routine painful procedures which can lead to short-term and long-term neurological morbidity. Music therapy and non-nutritive sucking are effective and feasible interventions to reduce procedural pain in the neonatal population.

LOCAL PROBLEM: Leadership in the neonatal intensive care unit (NICU) at a large pediatric hospital in the Southeastern United States identified the problem of unmanaged pain during routine procedures, including retinopathy of prematurity (ROP) exams. A multi-disciplinary group of nurses, music therapists, and developmental therapists collaborated to address the problem.

METHODS: This evidence-based practice improvement project evaluated the impact of implementing a pacifier-activated lullaby (PAL) device after ROP exams on pain, behavior, and heart rate of infants in the NICU. The project team collected biometric data prior to, during, and following ROP exams to determine infant response. Frequency of PAL use and other comfort measures were evaluated weekly to track compliance with the practice change. Outcome and process measures were compared to pre-intervention data.

INTERVENTIONS: The PAL device is a multisensory intervention providing music and encouraging non-nutritive sucking. In addition to standardized comfort measures provided by nursing, the music therapist used the PAL device with infants for 5 minutes following ROP exams.

RESULTS: Eligible infants using the PAL device ranged from 67% to 100% weekly, which exceeded the project aim of 50%. The rapid recovery of pain, heart rate, and behavior to pre-procedure levels within 5 minutes of using the PAL device was clinically significant compared to the pre-intervention group.

CONCLUSIONS: The PAL device was successfully integrated into eye exam procedures at the project site. Any improvement in pain management is important to prevent the negative consequences of pain on preterm infants’ development. Opportunities for future projects include expanding the use of the PAL device with additional painful procedures.