Quality Improvement Intervention Decreases Pain and Adverse Events Due to Heel Lances in Infants

Background: Studies have investigated ways to reduce infants’ pain during heel lancing, but research on preventing adverse events is scarce. This study investigated whether or not the number of infants with normal comfort (>8 and ≤14), distress (≤4), and pain (≤4) scores increased and whether or not the number of adverse events (blue and/or edematous heels and improperly placed incisions) decreased during and after heel lancing following an intervention. Methods: A pre- and post-quality improvement intervention including 189 and 186 heel lances, respectively, in infants (postmenstrual age ≥ 28 + 0 to ≤ 43 + 6 weeks) was conducted in May to July 2020 and April to July 2022. The intervention comprised five initiatives: skin-to-skin contact, comforting, sucrose/breastfeeding, warming cold heels, and ergonomics for staff. ComfortNeo score, along with distress and pain scores assessed the infants’ pain and discomfort before, during, and after heel lancing. Adverse events were assessed visually. Results: Post-intervention, there was a significant increase in the number of infants with normal pain and distress scores during (86% to 95%, p = 0.01, and 82% to 93%, p = 0.01, respectively) and after (95% to 99%, p = 0.04, and 90% to 99%, p < 0.01, respectively) heel lancing compared to the pre-intervention. A non-significant reduction in the number of adverse events was observed (41 to 30, p = 0.17). Conclusions: Cost-free procedural changes can decrease pain, discomfort, and adverse events in infants undergoing heel lancing. Painful procedures should be evaluated and optimized. Staff and parents should collaborate to manage pain and adverse events.