Jacqueline Legg, BSN, RN
Winchester Medical Center
June 15, 2017
Abstract--Ongoing Work/Project
Neonatal Abstinence Syndrome has been recognized for years; however, a nationwide increase in opioid exposed newborns has drastically changed the face of neonatal nursing and healthcare (Bagley, 2014; Toila, 2015). While many different scoring tools and treatment options have been developed and implemented worldwide, there are still significant inconsistencies across the board on how to safely and effectively wean these newborns and decrease their length of stay (LOS) (McQueen, 2016). With this increased patient population we have viewed traditional scoring tools including Finnegan and spoken with other experts in this field including Yale. The benefit of the family being with the infant is emphasized as well as improving nursing interventions that reduce overall anxiety for both infant and family and decrease the LOS (Abbett, 2012). In reviewing the literature our goal was and is to decrease exposure to opiates on the developing brain as well as creating a readiness to wean scale.
Based on our current statistics we have shown that through supportive comfort measures we are able to minimize the physiologic effects of withdraw including but not limited to the effects of central and autonomic nervous system dysfunction (MacMullen, 2014). As we have learned from other experts in this field having a collaborative group to standardize patient care policies decreases health care utilization, increases family satisfaction, decreases newborn exposure to opiates, and overall provides improved outcomes (Patrick, 2016). This two group comparison study will determine if this tool is making a difference in our length of stay positively or negatively as well as allow us to comfortably and safely wean our patients. As we continue to review the literature we will review inter-rater reliability and have local and national experts assess this modified scoring tool. In addition we will continue to ensure the parents understand they are the primary treatment in their infant’s care as outlined in our NAS Parent Contract and their expectations while in the Neonatal Intensive Care Unit (NICU).
With current changes in practice and implementation of our NAS protocol our length of stay has drastically decreased. Pre-NAS protocol for all babies LOS 41.5 days and post-NAS protocol LOS 22.6 days (46% reduction), all term babies pre-NAS protocol LOS 50.4 days, post-NAS protocol 22.8 days (56% reduction), single substance exposed term pre-NAS protocol 54.2 days and post-NAS protocol 19.6 days (64% reduction) and multi substance exposed term pre-NAS protocol 47.7 days and post-NAS protocol 27.8 days (42% reduction). Impact on LOS of babies relative to percentage of baby’s hospital stay that mother provides comfort measures 0% at 22.3 days (only 3 babies), </=25% at 29.6 days, </=50% at 28.8 days, </75% at 24.6 days, and >75% at 17.8 days. In addition our clonidine and morphine exposure has decreased exponentially with Clonidine exposure pre-NAS protocol 44.3 days and post-NAS protocol at 18.9 days and morphine exposure pre-NAS protocol 30.3 days and post-NAS protocol 17.2 days. With our continued multi-center and multi-disciplinary quality improvement collaborative we continue to decrease our length of stay, decrease opioid exposure, and effectively include these families as their infant’s primary treatment.
Keywords: Neonatal Abstinence Syndrome, Opioid Exposed Newborns, The Finnegan Neonatal Abstinence Scoring System