Format

Send to

Choose Destination
J Perinatol. 2018 Aug;38(8):1114-1122. doi: 10.1038/s41372-018-0109-8. Epub 2018 May 8.

Quality improvement initiative to improve inpatient outcomes for Neonatal Abstinence Syndrome.

Author information

1
Pediatrics, Boston Medical Center, Boston, MA, USA. Elisha.Wachman@bmc.org.
2
Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
3
Pediatrics, Boston Medical Center, Boston, MA, USA.
4
Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
5
Obstetrics, Boston University School of Medicine, Boston, MA, USA.
6
Boston University School of Public Health, Boston, MA, USA.
7
Boston University School of Medicine, Boston, MA, USA.
8
Pharmacy, Boston Medical Center, Boston, MA, USA.
9
Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.

Abstract

OBJECTIVES:

To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program.

DESIGN:

Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment.

RESULTS:

Pharmacologic treatment decreased from 87.1 to 40.0%; adjunctive agent use from 33.6 to 2.4%; hospitalization length from a mean 17.4 to 11.3 days, and opioid treatment days from 16.2 to 12.7 (p < 0.001 for all). Total hospital charges decreased from $31,825 to $20,668 per infant. Parental presence increased from 55.6 to 75.8% (p < 0.0001). No adverse events were noted.

CONCLUSIONS:

A comprehensive QI program focused on non-pharmacologic care, function-based assessments, and methadone resulted in significant sustained improvements in NAS outcomes. These findings have important implications for establishing potentially better practices for opioid-exposed newborns.

PMID:
29740196
DOI:
10.1038/s41372-018-0109-8

Supplemental Content

Full text links

Icon for Nature Publishing Group
Loading ...
Support Center