Johns Hopkins Neonatal Pain Management Algorithm to Decrease Pain Among Neonates - Dr. Dana London

Abstract: Neonates in the NICU often undergo painful procedures that, if not properly managed, can negatively impact physiological stability and neurodevelopment. Although non-pharmacological pain strategies are evidence-based and effective, their use is inconsistent in practice. Purpose: This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to implement the Johns Hopkins Neonatal Pain Management Algorithm (2023) to reduce procedural pain during routine NICU procedures and promote consistent, evidence-based non-pharmacological pain management. Methods: Using Orlando’s Nursing Process Theory and Kotter’s Change Management Theory, NICU staff were trained through structured workshops and provided with reference tools to integrate the algorithm into clinical workflows. NIPS pain score data were collected from 28 neonates undergoing heel sticks, IV insertions, NGT placements, and suctioning, before and after implementation. Results: Post-intervention findings showed a statistically significant reduction in pain scores across all procedures. Implementation led to more consistent application of non-pharmacological strategies, supported by strong leadership engagement and comprehensive staff education. Implications for Practice and Future Projects: This project demonstrates the effectiveness of standardized, nurse-led, non-pharmacological pain protocols in improving neonatal outcomes. Long-term sustainability is supported by unit champions, protocol embedding, and regular audits. The initiative aligns with DNP Essentials by advancing clinical leadership, interprofessional collaboration, and evidence-based care. Future projects may expand stakeholder involvement and assess long-term developmental impacts.