Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Comparing N-PASS and NIPS

Improving Pain Measurement in the Neonate

Desai, Amita, DNP, CRNP, NNP-BC; Aucott, Susan, MD; Frank, Karen, DNP, APRN-CNS; Silbert-Flagg, JoAnne, DNP, CRNP, IBCLC

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000521
Clinical Issues in Neonatal Care

Background: Proper assessment of pain is essential to allow for safe and compassionate care of infants in the neonatal intensive care unit (NICU). The Neonatal Infant Pain Scale (NIPS) used in an urban level IV NICU addresses acute pain but may not adequately measure chronic neonatal pain.

Purpose: The purpose of this quality improvement study was to improve acute and chronic pain measurements for neonates in an NICU through implementation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS).

Methods/Search Strategy: An evidence search for a comprehensive tool to assess neonatal pain in the setting of a 45-bed level IV NICU was completed. The N-PASS was found to be inclusive of measuring acute and chronic neonatal pain. Participants for a quality improvement study, including NICU nurses and providers, were educated on the N-PASS. Nurses documented in the N-PASS and the NIPS during routine pain assessments for NICU infants for comparison. Participants completed a survey assessing knowledge of the N-PASS.

Findings/Results: When compared, the N-PASS generated 98% of pain scores greater than the NIPS. Surveys demonstrated an increase in staff knowledge for the N-PASS.

Implications for Practice: Implementation of a multidimensional pain tool that measures acute and chronic pain is essential for proper pain assessment. Providers can manage neonatal pain when accurate documentation is available.

Implications for Research: Further research evaluating guided management of acute and chronic pain scores on the N-PASS would aid hospital policies on therapies for neonatal pain.

Neonatology, The Johns Hopkins Hospital (Drs Desai and Aucott), and; Johns Hopkins University School of Nursing (Drs Frank and Silbert-Flagg), Baltimore, Maryland.

Correspondence: Amita Desai, DNP, CRNP, NNP-BC, Johns Hopkins NICU, 1800 Orleans St, Bloomberg 8 North, Baltimore, MD 21287 (

Institution: The Johns Hopkins Hospital.

The authors thank Dr Leah Jager and Stephanie Hughes, RN, for their assistance with statistical analysis and staff education with this quality improvement study.

There are no competing interests for coauthors.

© 2018 by The National Association of Neonatal Nurses