Improving the Care for Infants Experiencing Neonatal Withdrawal

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Phelps, Erica
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Background: Management of neonatal withdrawal often involved admission to neonatal intensive care (NICU), outdated scoring tools (Finnegan), and opioid administration. Strategies resulted in prolonged hospitalization, mother-infant dyad separation, threats to breastfeeding establishment and exposure to medications. Literature suggested that care approaches promoting non-pharmacologic and family engagement strategies successfully decreased length of stay, use of medications, and overall cost of care.|Purpose: The purpose of this project was to decrease the average length of stay (by 25%) for infants born with prenatal exposure to illicit and prescription drugs without increasing readmission rates. Secondary aims included: decrease NICU admissions (by 33%), decrease use of scheduled opioids (by 33%), and increase breast milk feedings at discharge (by 33%).|Methods: A knowledge-focused trigger led a multidisciplinary team to evaluate the literature and utilize the Iowa Model, DMAIC quality improvement framework, and PDSA cycles. Interventions included modifications to assessment tools and treatment criteria, optimization of non-pharmacologic care, as-needed medication dosing, prenatal consultation, and minimum hospitalization standardization. Ultimately the Eat, Sleep, Console care methodology was adopted, and Finnegan scoring was discontinued.|Results: Outcomes demonstrated achievement of all project aims. The average length of stay ultimately decreased by 67% during the control phase. Additionally, there was a 71% decrease in NICU admissions and a 103% increase in patients discharging home with breast milk feedings. Zero patients required scheduled opioids (100% reduction) and zero were readmitted within one week of discharge.|Implications for Practice: The Eat, Sleep, Console care model was adopted as standard of practice for withdrawal management in the newborn nursery and Level III NICU. An Eat, Sleep, Console Implementation Toolkit was developed and disseminated across the healthcare system for consistency in care delivery across the enterprise. Electronic documentation, education materials and clinical resources were developed and utilized for practice roll-out across sites.
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