Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses

8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses

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Copyright 2014 Wright and Retskin NAS

Inter-Observer Reliability ofthe Modified Finnegan Score

in a Population of Neonatal

and Pediatric Nurses

Cathy Retskin, MSN, RNC

DNP Candidate Walden University

Mary Ellen Wright, MSN, APRN, CPNP

PhD Candidate Florida Atlantic University!"#$%&'() +,-. /0)12&3 435 6%&'()


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History of Mission Hospital Neonatal Abstinence Syndrome/Neonatal Withdrawal Initiatives

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Timeline of Mission Health NAS InitiativeYears of Effort

Aim: To provide consistent, comprehensive, caring approaches

to infants and families affected by NAS


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Opportunities to Standardize Care Processes

Murphy-Oikonen, Motelpare, Bertoldo, Southon & Persichino, 2010. Retrospective cohort comparison pre and post implementation of

clinical practice guideline.

Conclusion: Decrease in Finnegan ScoresDecrease in Length of Stay

Identification

Evaluation

Treatment

Discharge


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Mission Process Mapping

Just One Example

Details not visible: Point just to show broad view of mapping

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All Areas had Opportunities for Improvement

Formed Sub-Committees to address the opportunities in the areas of

identification, evaluation, treatment and discharge.

Steering committee coordinates the overall initiative with reports from

the sub-committees.

Example of initiative derived from looking at evaluation:

Inter-Observer Reliability (IOR) of the Modified Finnegan of Nurses

from Mother/Baby, Pediatrics, PICU, NICU and nurses in the region.


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EvaluationInter-Observer Reliability of Modified Finnegan Score

Origin of study: Comments being made at provider meetings

Depends on what shift of nurses and who is doing the

Finnegan. . .

Impression that there was variability without evidence.

The purposeof the study was to determine if there is inter-

observer reliability (IOR) of the Finnegan Neonatal Abstinence

Scoring Tool (FNAST) among nurses caring for infants withneonatal abstinence syndrome (NAS) in the NICU, Mother/Baby

and PEDS/PICU units and regional nurses.


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Description of Nurses in Study

Education Level, Years Experience, Certification

Total n=122


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Methods

An interactive DVD developed

by Karen DApolito, PhD, APRN,

NNP-BC and Loretta Finnegan, MD

on the IOR of the FNAST was

used with permission.


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Methods

IRB approval, Mission Research Institute and Nursing ResearchCouncil Approval obtained.

Potential participants for this reliability study would come fromnursing staff in the NICU, Mother/Baby, and PEDS/PICU units andnurses in the region.

Participation in the study was conducted through annual education,staff meetings, Care Partners and regional member hospitals.

Consent to participate was obtained. Vignette was shown, and the nurses were asked to score using the

Modified Finnegan Scoring System for Neonatal Abstinence

Syndrome Comparison was made to the expert score and Inter-Class

Correlation for IOR was calculated using SPSS.


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Results

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IOR in Sections of the FNAST

The least inter-observer reliability was in the area of the Central

Nervous System with ICC at 0.603.

Question: Is that consistent in different tests of IOR? We may want asa collaborative to compare those findings.

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Discussion

Study offered opportunity for education.

Modified Finnegan Scoring was added to orientation, continuing

education for existing nurses.

Medical Resident education on Modified Finnegan scoring.

Sharing with providers the results and standardization.


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Standardizing the Environment of Finnegan ScoringWork currently underway

Score in standard environment

!Quiet

!Minimize noxious lights

!After feeding

!In mothers arms?


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Education to Move to Standardization of Creating theEnvironment for Modified Finnegan

Adding the standardization of creating the environment for scoringthrough:

Nursing Education

OrientationResident Education

Physician Service Line Provider Meetings

Quality Rounds

Huddles

Newsletters


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Informing Standardization through Work of Sub-Committees

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The nice thing about teamwork is that you alwayshave others on your side

Margaret Carty


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References

D'Apolito K; MCN: The American Journal of Maternal Child Nursing, 1999 May-Jun; 24 (3): 138-44.DApolito, K. & Finnegan, L. (2010). Assessing signs & symptoms of neonatal abstinence syndrome

using the Finnegan Scoring tool: An inter-observer reliability program [DVD]. Nashville, TN:NeoAdvances, LLC.

Finnegan, L., Connaughton, J., Kron, R. & Emich, J. (1975). Neonatal abstinence syndrome:Assessment and management.Addictive Diseases: An International Journal. 2(1), 677-687.

Franck, L.S., Harris, S.K., Soetenga, D.J., Amling, J.K., Curley M.A. The withdrawal assessment tool 1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal

symptoms in pediatric patients. (2008). Pediatric Critical Care Medicine. 9(6), 573-580.Murphy-Oikonen, J., Montelpare, W.J., Bertoldo, L., Southon, S.,

Persichino, N. (2012). The impact of clinical practice guideline on

infants with neonatal abstinence syndrome. British Journal of Midwifery, 20(7),

493- 501

Retskin, C.M. & Wright, M.E. (2013). Inter-Observer Reliability of the Modoified Finnegan Neonatal

Abstinence Scoring Tool in an Acute Care Setting. Poster presentation at the 2013 VermontOxford Network Annual Meeting. Manuscript submission

Zimmermann-Baer U, Ntzli U, Rentsch K, Bucher HU. (2010). Finnegan

neonatal abstinence scoring system: normal values for first 3 days and weeks 5-6 in

non-addicted infants. Addiction. 2010 Mar;105(3):524-8.

Documents

Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses