ORIGINAL ARTICLE Procedural pain in neonates in Australian hospitals: A survey update of practices Jann Foster, 1,3,4 Kaye Spence, 5,9 David Henderson-Smart, 3 Denise Harrison, 6,7,10,11 Peter H Gray 8 and John Bidewell 2 1 School of Nursing and Midwifery, 2 School of Science and Health, University of Western Sydney, 3 Central Clinical School – Discipline of Obstetrics and Gynaecology, 4 Sydney Nursing School, University of Sydney, 5 Grace Centre for Newborn Care, Sydney Children’s Hospitals Network, Sydney, New South Wales, 6 Critical Care and Neurosciences, Murdoch Children’s Research Institute, 7 Faculty of Medicine, Dentistry and Health Children’s, The University of Melbourne, Melbourne, Victoria, 8 Newborn Services, Mater Mothers’ Hospital, Brisbane, Queensland, Australia and 9 School of Nursing and Midwifery, Queens University, Belfast, Northern Ireland and 10 Children’s Hospital of Eastern Ontario (CHEO) Research Institute, 11 Faculty of Health Sciences, University of Ottawa, Ottawa, Canada Aim: The study aims to determine whether there has been improved uptake of the evidence for the management of procedural pain in neonates throughout Australia. Methods: An Australian-wide survey was undertaken to determine the use of breastfeeding and sucrose and whether a clinical practice guideline (CPG) or pain assessment tool was used. Results: Data were available from 196 (91%) of the 215 eligible hospitals. A CPG informed the management of neonatal pain in 76 (39%) of the hospitals. There was wide variation in their use between the states, and a significantly higher use of a CPG in higher-level care units. A pain assessment tool was only used in 21 (11%) of the units with greater use in the higher level care neonatal intensive care units (50%) and surgical neonatal intensive care units (80%). Awareness of breastfeeding for procedural pain was reported by 90% of the 196 respondents while 78% reported that it was actually used. Awareness of sucrose for procedural pain was lower than breastfeeding at 79%, with 53% reporting that they used sucrose in their unit. Overall, 89% of the respondents reported that either breastfeeding or sucrose was used for the management of procedural pain in their units. Conclusion: There has been an increase in awareness and use of sucrose and breastfeeding for procedural pain in Australia since previous surveys were undertaken in 2004. Continued resources, local pain champions and a national interest group to promote the use of pain management for procedural pain in neonates are needed for continued uptake of the evidence. Key words: analgesia; infant; neonatology; pain management. What is already known on this topic 1 There has been a gap between research findings and clinical practice with regard to pain management in infants. 2 The majority of Australian neonatal units have no policy to guide pain management. 3 The majority of Australian neonatal units do not regularly under- take pain assessment. What this paper adds Since surveys were undertaken in 2004: 1 Awareness and use of evidence-based strategies such as sucrose and breastfeeding for procedural pain in neonates has substantially increased. 2 There has been a 50% increase in neonatal units with a policy to guide pain management. 3 There has only been a small increase in the number of neonatal units undertaking pain assessment. An evidence-practice gap occurs when knowledge is not imple- mented in practice. Awareness of an evidence-practice gap in the management of newborn pain 1,2 led to a national project for setting up a process to close this gap. The project commenced in 2006 and was named the Practice Evidence Gap Strategy (PEGS). It involved neonatal intensive care units (NICUs) and post-natal wards in 23 tertiary hospitals throughout Australia. Nine district hospitals with a special care nursery (SCN) were also included. Clinicians in units participating in the PEGS project were provided with documented research evidence, newsletters, posters, parent information brochures and critical appraisal edu- cational workshops with the goal of improving pain manage- ment practices. 3 Formal and informal networks can assist in the dissemination of knowledge, awareness and eventual practice change. 4 The Correspondence: Dr Jann Foster, Centre for Perinatal Health Services Research, University of Sydney, City Road, Sydney, NSW 2005, Australia. Fax: 93517742; email: j.foster@bigpond.net.au Declaration of conflict of interest: None. Accepted for publication 13 March 2012. doi:10.1111/jpc.12064 Journal of Paediatrics and Child Health (2012) © 2012 The Authors Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 1