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Welcome to the OPQC NAS June Action Period Call
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Neonatal Abstinence Syndrome Project
June Action Period Call
Ohio Perinatal Quality Collaborative June 2015
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Time Topic Presenter
12:00 pm Welcome & Agenda Review Susan Ford, RN
12:05 pm Data Overview – May Results
Scott Wexelblatt, MD
12:15 pm NAS- Upward & Onward • NAS Awareness Week in OH • Site 1 • Orchestrated Testing
Susan Ford Presenter 1 Scott Wexelblatt
12:50 pm Team Discussion – Q&A All teams
12:55 pm Next Steps •Save the Date Fall Learning Session •Data Submission Reminder •MPR/PDSA Reminder
Susan Ford
Agenda
Promedica Toledo Children’s
Miami Valley
Mercy Anderson
Aultman
Mt. Carmel East OSU
UH Rainbow Babies & Children’s
Bethesda North Hospital
Nationwide Dublin Methodist
Akron Children’s Summa
Cincinnati Children’s
Hillcrest Hospital Fairview Hospital
Cleveland Clinic
Dayton Children’s
Nationwide Riverside Methodist
Nationwide Grant
Nationwide Mt. Carmel St. Ann’s
UH Cincinnati
Good Samaritan Hospital
MetroHealth
Mt. Carmel West Nationwide Doctor’s
Akron Children’s
Nationwide Children’s
Mercy Children’s Hospital
Atrium Medical Center
Fort Hamilton
Mercy Hospital Fairfield
Mercy Medical Center Canton
The Christ Hospital
St. Rita’s Medical Center
Southview Medical Center
Good Samaritan Hospital Dayton
Kettering
Mercy Health West
Southern Ohio Medical Center
Genesis Healthcare System
OhioHealth MedCentral Mansfield
Marion General
Elyria Medical Center -UH
Mercy Regional Medical Center Lorain ProMedica
Bay Park
Lima Memorial Health System
Springfield Regional Medical Center
Adena Regional
Medical Center
Soin Medical Center
Upper Valley Medical Center
Licking Memorial Health System
NAS Participating Sites 2014
1/2014 start Level 3 and Level 2 teams
Akron Children’s
St. Elizabeth Health
Center/Mahoning Valley
Trumbull Memorial
4/2014 start Level 2 teams
Key Driver Diagram Project Name: OPQC Neonatal NAS Leader: Walsh
SMART AIM
KEY DRIVERS INTERVENTIONS
By increasing identification of and
compassionate withdrawal treatment for full-term infants born with
Neonatal Abstinence Syndrome (NAS), we will reduce length of stay by 20% across participating sites by June 30, 2015.
Improve recognition and non-judgmental support for Narcotic
addicted women and infants
Connect with outpatient support and treatment program prior to
discharge
Standardize NAS Treatment Protocol
Optimize Non-Pharmacologic Rx Bundle
Initiate Rx If NAS score > 8 twice. Stabilization/ Escalation Phase Wean when stable for 48 hrs by 10%
daily.
Swaddling, low stimulation. Encourage kangaroo care Feed on demand- MBM if appropriate
or lactose free, 22 cal formula
All MD and RN staff to view “Nurture the Mother- Nurture the Child”
Monthly education on addiction care
Attain high reliability in NAS scoring by nursing staff
Partner with Families to Establish Safety Plan for Infant
• Fulltime RN staff at Level 2 and 3 to complete D’Apolito NAS scoring training video and achieve 90% reliability.
Establish agreement with outpatient program and/or Mental Health
Utilize Early Intervention Services
Collaborate with DHS/ CPS to ensure infant safety.
Prenatal Identification of Mom Implement Optimal Med Rx Program
Engage families in Safety Planning. Partner with other
stakeholders to influence policy and primary
prevention. Provide primary prevention materials
to sites.
To reduce the number of moms and babies with narcotic exposure, and
reduce the need for treatment of NAS.
GLOBAL AIM
Site Specific Data Folders • Site specific data, as well as regional aggregate
charts are now in your hospital’s folder on SharePoint. • Some sites may also see a list of queries in an excel
document in their OPQC data folder on SharePoint. – Not every site will see a list of queries
• Don’t be concerned if your site does not have a list; it just means we do not have any queries for you at this time.
• These questions are being asked to strengthen our data and to verify that the data was captured as each of you intended. Do not assume that the database is wrong! We are simply verifying the data entered into the database are accurate.
Data Verification (Queries)
• On the April 2015 Action Period call sites received training on how to resolve the queries. – If you need a refresher or missed the April AP call
• Please contact us! We are happy to go over this process with you.
– Contact Jenney Nobbe directly at [email protected] or 513-803-8097
– Or contact the OPQC general help e-mail ([email protected]) • The training slides from April are also located on the
OPQC SharePoint (www.opqc.net) in the data collection area of the page.
NAS: Onwards and Upwards
Source: http://happysomeone.com
• Provide primary prevention materials to sites.
Partner with other stakeholders to
influence policy and primary prevention.
Key Driver:
Intervention:
Primary Prevention
Ohio Collaborative to Prevent Infant Mortality (OCPIM) Summit;
December 4, 2014
NAS Awareness Week in Ohio
NAS Awareness Week Activities
• July 1-7 • Proclamation from the
Governor’s Office • OPQC efforts
– Infographic distribution – Social media posts
New NAS Print Materials
• Developed with Burness Communications: – Brochure targeting prescribers – Brochure targeting women in recovery from
addiction – Poster targeting women in recovery from
addiction
• NOTE: These are all drafts; the final versions will be released closer to NAS Awareness Week
Prescriber Brochure
• Audience: Any professional who prescribe opiates to women of reproductive age
• Call to Action:
Before you prescribe opiates to a woman of reproductive age:
• consider alternatives • discuss contraception • check OARRS
Patient Brochure • Audience: Women in recovery
or treatment
• Call to Action: If you are in treatment or recovery for addiction: • take this time to focus on
yourself, and • do what you can to delay
pregnancy (ex- getting a long-acting reversible method of contraception)
• Poster is forthcoming
What’s next?
• Details in your next OPQC newsletter (delivered on June 19) – Social Media Plan with suggested posts – JPEG file of our NAS infographic
• By July 1st – Deliveries of the printed
Prevention Pieces will be sent to each site
NAS Volunteer Specialist Program at Site 1
Presenter 1
………………..……………………………………………………………………………………………………………………………………..
NAS – History of Problem • A 6-fold increase in the number of patients at site 1 with
NAS from 2004-2008 • 200 NAS patients in 2008 • NAS 7.6% of admissions in 2009 and continues to increase • NAS LOS exceed 58 days prior to 2009 • Methadone protocol established in early 2009 • LOS decreased to 31 days • Literature suggested decreased LOS with oral morphine • Established QI Team to reduce LOS for neonates with NAS
in 2009
………………..……………………………………………………………………………………………………………………………………..
NAS Today • QI team transformed into the Neonatal Services
NAS Taskforce with representatives from all units as well as non-site NICU’s in city and hospitals in region
• Numbers of babies diagnosed continues to grow!
• Length of stay has continued to decrease with an average length of stay 20.3 days with a range of 12.6 to 28.7 days
………………..……………………………………………………………………………………………………………………………………..
Background for Volunteer NAS Specialist Program • The main campus NICU that cares for NAS
babies, had increasing requests for the need of a constant attendant to help care for this population.
• The use of constant attendants leads to increased costs
• Nursing administration asked QI Medical Director to come up with solution to the increasing constant attendant hours and costs.
………………..……………………………………………………………………………………………………………………………………..
Development of Volunteer Specialist Program
• Research of best practices from other institutions led to the idea of using volunteers to help care for the babies.
• Contact was made with the volunteer coordinator at East Tennessee Children’s Hospital (ETCH) to learn about their program.
• Committee formed at site 1 to discuss the idea and how to implement in summer of 2014.
………………..……………………………………………………………………………………………………………………………………..
Development of Volunteer Specialist Program
• Interdisciplinary committee consisted of Associate Medical Director of site 1, Co-chairs of NAS Taskforce, manager of the NICU, chair of the NICU NAS committee, NICU Volunteer Coordinator, NICU educator and manager of volunteers for site 1.
• Review of materials obtained from ETCH was done and changes were made to adapt to site 1’s culture.
………………..……………………………………………………………………………………………………………………………………..
Development of Volunteer Specialist Program
• Grant dollars became available to pay for start up of program and budget was developed.
• Educational program and materials were developed by the group members over a period of 6 months.
………………..……………………………………………………………………………………………………………………………………..
Volunteer NAS Specialist Program
• Major differences between site 1 program and ETCH program – Name for Volunteer program – Identification of volunteers – Who volunteers can be
………………..……………………………………………………………………………………………………………………………………..
Volunteer Specialist Requirements
• Current site 1 volunteer in the NICU • In good standing • Interest in working with NAS babies
and families • Minimum 6 month commitment to the
program
………………..……………………………………………………………………………………………………………………………………..
Volunteer Specialist Program
• Began in January 2015 • Goal of program - To help nurses with
fussy babies and to decrease use of constant attendant hours.
• To date 2 classes have been held • 8 experienced volunteers have been
trained.
………………..……………………………………………………………………………………………………………………………………..
Volunteer Specialist Program • Volunteers training consists of information on:
– The problem in the US, Ohio, Columbus and region – Addiction, specifically maternal addiction – NAS signs/symptoms – Comfort and care techniques – Communication techniques and working with
families – Review of NAS paperwork
• Pre and Posttests administered to determine increase in knowledge occurred
………………..……………………………………………………………………………………………………………………………………..
Are We Making a Difference? • Data is currently being analyzed on time and
interventions that NAS Volunteer Specialists have documented.
• LOS has decreased
• Pre/Posttests results
– Pretest Score - Range 60-90; Mean 75
– Posttest Score – 100
• Positive feedback from nursing staff on program
• Volunteers are asking to be part of program.
Next steps for the NAS Project
What Have we Accomplished… • Standardized Finnegan
scoring with reliability testing
• Standardized approach to non-pharmacologic care based on best available evidence
• Standardized treatment protocol based on best available evidence
• Improved non-judgmental care
• Better links with community resources
Length of Opiate Tx
16.3 days 14 days
LOS
20.6 days 18.5
days
What do we still have to learn… Areas where you are NOT convinced
about the evidence
What do we still have to learn… Areas where you are NOT convinced
about the evidence
What do we still have to learn… Areas where variation exists among our teams
What do we still have to learn… Areas where variation exists among our teams
What do we still have to learn… Areas where variation exists among our teams
What do we still have to learn… Areas where variation exists among our teams
Non-Pharmacologic Bundle Pharmacologic Bundle
What do we still have to learn…
“Orchestrated” Testing: Coordinate PDSA testing in a network to
evaluate Ideas for improvement
What could we examine with Orchestrated Testing?
• Methadone vs. Morphine • 22 kcal/oz vs. 20 kcal/oz
as standard feeding • Low vs. High Finnegan
threshold for initiating pharmacologic treatment
• Phenobarbital vs. Clonidine as secondary medication
• Different dosing protocols • ???
Next Steps… • Plan to attend the July Webinar
– Make sure you have both physician AND nursing representation!
• Let us know if you are interested in
participating on a Steering Committee • Share your ideas for areas that we could
examine using orchestrated testing
Questions and Discussion
• Questions for Dr. Wexelblatt?
We’re Changing our OPQC Learning Session Schedule…
from: Winter/Summer to: Fall/Spring
Save the Date: September 28th
Next Steps
• Please respond to any data queries you have received.
• Please submit NAS Data by June 30th.
Remember to please submit and check “No Eligible Babies for the Month” if there were no NAS patients at your site.
• Monthly Progress Report was sent to Key
Contacts last Friday; due June 30th.
The OPQC NAS Project is funded by The Ohio
Department of Medicaid
