Welcome to the OPQC NAS November Action Period Call

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Neonatal Abstinence Syndrome Project

Action Period Call

Ohio Perinatal Quality Collaborative November 21, 2014

Welcome!

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Time Topic Presenter

12:00 pm Welcome, Agenda Review, sign in Susan Ford

12:05 pm Data Overview – October Results Scott Wexelblatt, MD

12:15 pm Community Resources • Site 1 • Site 2 • Site 3 • Discussion/Team Sharing

Presenter 1 Presenter 2 Presenter 3 All Teams

12:50 pm Next Steps •PDSA Submissions •Save the Date –

•OCPIM Summit •OPQC Learning Session

•Data Submission Reminder •Monthly Progress Report Reminder

Susan Ford

Agenda

Roll Call: Please sign in with your hospital affiliation and the

names of your team members on the call in the Question box

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

Community Resources for Patients and Providers

Site 2

Presenter 2

Our Community Resources • Project Cure – Methadone Clinic. Will take pregnant women up to 29

weeks; their waiting list is usually 2-3 weeks.

• Nova House – Residential treatment. (No children allowed.) Does not prescribe Methadone or Subutex; instead focuses on the Substance Abuse Process.

• Women’s Recovery – Residential treatment facility. Women allowed to have their children with them. Associated with TCN Outpatient Clinic (Behavior Health and Addiction Services)

• Cornerstone – 3 sites in our area. Substance Abuse Rehabilitation. Outpatient setting Subutex Clinic. Will take pregnant women up to 29 weeks.

• Samaritan Behavioral Health – Mental Health and Substance Abuse Outpatient Clinic.

.

Community Resource Benefits

Patient Benefit • The need for these agencies

is great in our area. The need currently exceeds the availability.

• We have found patient involvement with these facilities often assists in increasing stability in their lives which can lead to a decrease in relapse.

Hospital/Provider Benefit • Increased support for our

patients.

• Better care for the moms and their babies.

• We have seen higher rates of

visitation from mothers who are actively involved in these support agencies.

Site 2

Presenter 2

Collaboration between the Women and Children’s Unit and

OB/GYN & Pediatric Offices

• Dedicated Women and Children’s Social Worker Time is Spilt – Beginning and end of each day and group time is in hospital – The middle of every day is dedicated to appointment

with patients in the OB/GYN or Pediatric office.

• Address Patient’s Social Problems throughout her Pregnancy (addiction, homelessness, non-custody of children, food insecurity, miscarriage, fetal demises, anxiety, depression, post traumatic stress disorder, post partum depression, NAS, child care/parenting , mandated reporting)

How addictions issues are addressed The Modified 5 Ps Referral-to LISW Assessment Explanation of Hospital

Policies 1.Hold on infant 2. Scoring 3. Cord Stats Patient Options 1. Inpatient 2. Clinics 3. Groups Addressing Social Needs

Subutex Group • Monthly Centering Meeting • Weekly Meetings • Random Drug Screens • Outside attendance of AA/NA

meetings • Journals, Feelings/ Emotions,

Gratitude Lists • Life Skills

Successes-27 Babies Born- Only 2-Pharmological Interventions

Community Partners that Benefit Patients

Addiction Related

• Scioto Paint Valley ADAMH Board *

• SPVMH/211/Crisis Center * • Ross County’s Drug Task Force • Recovery Council * • Local AA/NA Groups * • Children’s Services * • County Health Departments* • Health Recovery Services* • Stepping Stones*

*Available in Multiple Counties

Pregnancy/Family • Ross County Domestic Violence

Commission • Family and Children First

Council • Elizabeth’s Hope * • Life Centers • County Health Departments* • Help Me Grow* • WIC* • Love Inc. • Church Groups

SITE 3

PRESENTER 3

OCWTP's 8 Regional Training Centers

THE TRAINER/COACH POOL APPROXIMATELY 250 INDEPENDENT CONTRACTORS

Participant/Trainee Populations Served Through the OCWTP

Case Workers

Child Welfare

Supervisors and

Managers

Foster Caregivers

and Adoptive Parents

Training Delivery Methods Focused on Building Competency

Workshops

• Awareness, knowledge, beginning application

• Focused content

Learning Labs

• Application and skill development

• Practical application

GAPS

• Application and skill development

• Learner driven • Focused on

filling skills and knowledge GAPS

• Brainstorming and problem solving

Coaching

• 1:1 home or work site based

• Individualized plan for learner

• Skill enhancement, working toward mastery

Discussion and Questions • What has been your

experience partnering with Community Agencies?

• What barriers have you encountered in

attempting to partner with Community Agencies?

• Questions for our presenters ?

PDSA’s PDSA Key Drivers

Improved recognition and non-judgmental support for Narcotic addicted women and

infants

High reliability in NAS scoring

Non-pharmacologic bundle

Standardized NAS Treatment Protocol

Connecting with outpatient support and

treatment program prior to discharge

Partner with families to establish safety plan for

infant

Save the Date(s)!

OPQC Learning Session

• Save the Date: January 26, 2015 at the Columbus Marriott (Airport)

• PLEASE be certain to have your Social Worker

attend with your team if possible! • Opportunity to “Steal Shamelessly & Share

Seamlessly” with other teams

• Update your team contact info if changes have occurred from last January

Next Steps

• Continue testing small tests of change (PDSA) • Please submit NAS Data by November 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 will be sent to Key Contacts this week; due NOVEMBER 30th

Happy Thanksgiving!! We are so thankful for each of YOU and your hard work and dedication to the mothers and babies you care for! Best wishes for a Happy Thanksgiving!

The OPQC NAS Project is funded by The Ohio

Department of Medicaid