Summary of Recommendations.

What we know	Many governmental agencies, professional associations, and other groups have released neonatal pain management guidelines. The release of a guideline does not ensure that evidence-based care will be adopted in the neonatal intensive care unit setting. The monitoring of quality indicators provides a measure for the adoption of standards of care and is an effective method for improving the quality of practice. Projects employing a multihospital collaborative quality improvement model have shown greater effectiveness than single-site projects.
What needs to be studied	The development of a neonatal pain quality improvement collaborative program based on the current standards of care for pain management in neonatal intensive care units (NICUs) in Japan The use of pain management quality indicators to evaluate NICU quality improvement collaborative programs Determination of whether neonatal pain improvement collaborative programs enhance local quality improvement efforts in Japan
What we can do today	Introduce electronic medical record pain management forms based on practice standards to support standardized assessment and documentation as well as individualized care planning Use pain management quality indicators to track the progress of quality improvement efforts and motivate staff Provide education, structure, and feedback to support tests of change