PQCNC April NAS Webinar: OPQC - Improve Consistency in
Transcript of PQCNC April NAS Webinar: OPQC - Improve Consistency in
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OPQC
Ohio Perinatal QualityCollaborative
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The Ohio Perinatal QualityCollaborative
Obstetrics Neonatal39-WeekSchedule
dDeliveries withoutedicalindicatio
n
Steroids !orwoen at risk
!or "reterbirth
#$%&'( - 33 )'(*Done Transitionto +C Surveillance
,ncrease +irth
Dataccurac
y .Onlineodule
s
S"read
to allaternit
yhos"italsin Ohio
2014:
Progesteroneto Reduce
Preterm BirthRisk
+loodStrea
,n!ections/
0i1h
reliabilityo! lineaintenance bundle
2se o!huanilk inin!ants
$$-$9weeks
$&4%/
NeonatalbstinenceSyndroe
OC0NS in) C05s
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Proedica Toledo
Children5s
6iai7alley
6ercy nderson
ultan
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CincinnatiChildren5s
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Cleveland Clinic
DaytonChildren5s
Nationwide :iverside6ethodist
Nationwide rant
Nationwide 6t8 Carel St8
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6t8 Carel WestNationwide Doctor5s
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=ey Driver Dia1raProject Name: OPQC Neonatal NAS Leader: Walsh
SMART AIM
KEY RI!ERS INTER!ENTIONS
By increasingidentifcation o and
com!assionate"ithdra"al treatmentor ull#term inants$orn "ith %eonatal
&$stinence
'yndrome (%&')* "e"ill reduce length ostay $y 20+ across
!artici!ating sites $y ,une 30* 201-.
m!rove recognition andnon#udgmental su!!ort or%arcotic addicted "omen
and inants
onnect "ith out!atientsu!!ort and treatment
!rogram !rior to discharge
'tandardie %&' reatmentProtocol
!timie %on#Pharmacologic R5 Bundle • nitiate R5 %&' score 6 7 t"ice.
•'ta$iliation/ 8scalation Phase•9ean "hen sta$le or 47 hrs $y10+ daily.
•'"addling* lo" stimulation.•8ncourage kangaroo care
•eed on demand# ;B; ia!!ro!riate or lactose ree* 22 calormula
•&ll ;< and R% sta= to vie" >%urturethe ;other# %urture the hild?•;onthly education on addiction care
ttain hi1hreliability in NS
scorin1 bynursin1 sta@
Partner "ith amilies to8sta$lish 'aety Plan or
nant
;ulltie :N sta@ at >evel $ and3 to co"lete D5"olito NSscorin1 trainin1 video andachieve 9&A reliability8
• 8sta$lish agreement "ith out!atient!rogram and/or ;ental @ealth•Atilie 8arly ntervention 'ervices
olla$orate "ith
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OPQC NAS Project Aim
• Develop and implement a standardized process for the
identification, evaluation, treatment and dischargemanagement of an infant with neonatal abstinence
syndrome..
– Standardization of Scoring Tool
– Standardization of protocol bundles
• Non-parmacological !undle• Parmacological Treatment !undle
• Create a culture of compassion, understanding, and
healing for the mother infant dyad affected by the
problem of neonatal abstinence syndrome.
Te aim of te OPQC NAS Project is to increase the identification of andcompassionate withdrawal treatment for full-term infants born with !""
tereb# reducing te lengt of sta# for tese infants b# $%& across participating
sites b# 'une (%" $%)*.
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#mportance of !ssessment$what are we assessing%
Neonatal +itdra,al• Onset $ ours to da#s
• /uration )0 da#s to monts" self limiting
• AAP 1onitoring 2ecommendations
3 1inimum $-( da#s for an# maternal istor# ofdrug use
3 *-4 da#s if mom on multiple and5or long acting
drugs
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&hat is #nter-'ater 'eliability%
• #nter-rater 'eliability( e6tent to ,ic $
• pro7iders agree ,en using te same tool.
• )ethod( one person scores" ,ile
anoter
• obser7es8 eac independentl# scores"
ten
• compare
• *oal( 9%& inter-rater reliabilit#
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!" "coring by Clinical "taff Cohort +
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NAS Scoring b# Clinical Staff Coort $
&ll ulltime nursing sta= in our %/A com!lete the
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m!rove onsistency in
;odifed innegan 'coring• &ll sites use same tool
•
rain R% sta= to E0+ relia$ilityin scoring using
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;inne1an Scorin1 D7D .Workbook htt!://""".neoadvances.com/
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………………..……………………………………………………………………………………………………………………………………..
;inne1anScorin1 Tool
8rin L. Heels ;'* &PR%* %%P#B%&' askorce hair
%%P Program
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………………..……………………………………………………………………………………………………………………………………..
9hy use an assessmenttoolI
• 200- study: 71+ centers surveyed use assessmenttool* -2+ have guidelines (rocetti* &min* J ,ansonn* 200D)
• &llo"s or >common language?* decrease varia$ility*involve amilies
• Based on o!iate "ithdra"al
3 ne tool or all su$stance "ithdra"alI
• onounding actors
3 erm vs. !reterm vs. $eyond neonatal !eriod
3 'ta= training and com!etency maintenance 3 'u$ectivity
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………………..……………………………………………………………………………………………………………………………………..
NAS Assessment Tools
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>;odifed innegan?
• Originall# de7eloped in )94*8 :1odified; in )9
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innegan 'cored tems
Central NervousSyste
85cessive rying (2#3)
'lee! (1#3)
@y!eractive ;oro (2#3) remors (1#4)
ncreased muscle tone(2)
85coriation (1)
;yoclonic erks (3)
onvulsions (-)
utonoic NervousSyste
'"eating (1)ever (1#2)
reKuent a"ning (1)
;ottling (1)%asal 'tuMness (1)
'neeing (2)%asal laring (2)Res! rate (1#2)
astrointestinalSyste85cessive sucking (1)
Poor
eeding (2)
Regurgitation (2)
Proectile
Nomiting (3)'tools (2#3)
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%@ innegan raininginnegan raining ourses ( ;arch# &!ril 2010)
"o hal day %&' 9orksho!s rain the trainer ormat
m!lement standardied training o ne" sta=
"ith commercially !roduced !rogram(%eo&dvancesO)
ngoing com!etency or all sta= :eliabilityB e5tent to "hich 2 !roviders agree "hen using
the same tool.
6ethodB one !erson scores* "hile another o$serves eachinde!endently scores* then com!are
oalB E0+ inter#rater relia$ility
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i t t
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ngoing nter#raterRelia$ility
2013 %@ 'ta= 'urvey on innegan'coring:
• CD+ o R% sta= res!onded
• 1-.2 + elt some"hat or not comorta$le
concerns: scoring o slee! or older $a$ies*
e5coriation
• 3D+ "anted more education/training
• 2C+ o sta= "ere not conducting inter#rater relia$ility scoring !ro!erly
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Results• 2013 all R%s "atched: >&ssessing signs and
sym!toms o %eonatal &$stinence using the
innegan 'coring ool? video rom %eo&dvances
• %&' 'u!er Asers reeducated all sta=
• Lunch nF Learns "ith 2013 N% i%G %&'9e$inars
•
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PG Resources
• o!Kc.net Proects %&'Learning 'essions &rchives ,une2C* 2014 1:10#1:-0!m J 1:--#
2:3-!m innegan 'coring (Heels)
1D minute video o this !resentation is
on our "e$site
https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/Learning%20Sessions/June%2026,%202014%20Learning%20Session/Neo%20(3)%20110-150pm%20and%20155-235pm%20Finnegan%20Scoring%20(Keels).pdfhttps://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/Learning%20Sessions/June%2026,%202014%20Learning%20Session/Neo%20(3)%20110-150pm%20and%20155-235pm%20Finnegan%20Scoring%20(Keels).pdf
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P
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9hat are other hos!itals testingISteal Shaelessly-Share Sealessly
• @ave a !arent o$serve and !artici!ate "hen thenurse com!letes the inantFs scoring.
• rack an additional varia$le o the inant "eight onthe 'coring ool.
• eed the inant !rior to scoring does this im!act thescoreI
• ncrease inter#rater relia$ility among %A sta=other sites are "orking on this "ith their Post Partumand/or %e"$orn %ursery nursing sta=.
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