A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

Elisha M Wachman¹, Mary Houghton², Patrice Melvin³, Breanna C Isley⁴, Jennifer Murzycki⁵, Rachana Singh⁶, Susan Minear⁴, Kathryn Dee L MacMillan⁷, Debra Banville⁸, Amy Walker⁹, Teresa Mitchell¹⁰, Rose Galimi-Hayes¹¹, Selena Jorgensen¹², Daphne Remy Gomes¹³, Fran Hodgins¹⁴, Bonny L Whalen¹⁵, Hafsatou Diop¹⁶, Munish Gupta²

Affiliations

¹ Department of Pediatrics, Boston Medical Center, Boston, MA, USA. Elisha.Wachman@bmc.org.
² Newborn Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA.
³ Center for Applied Pediatric Quality Analytics, Children's Hospital Boston, Boston, MA, USA.
⁴ Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
⁵ Department of Pediatrics, Lowell General Hospital, Boston, MA, USA.
⁶ Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA.
⁷ Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA.
⁸ South Shore Hospital, Weymouth, MA, USA.
⁹ Cooley Dickinson Hospital, Northampton, MA, USA.
¹⁰ Department of Pediatrics, Mercy Medical Center, Springfield, MA, USA.
¹¹ Milford Regional Medical Center, Milford, MA, USA.
¹² Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
¹³ Department of Neonatology, Boston Children's Hospital, Boston, MA, USA.
¹⁴ Massachusetts Health Policy Commission, Boston, MA, USA.
¹⁵ Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA.
¹⁶ Massachusetts Department of Public Health, Boston, MA, USA.

PMID: 32678314
DOI: 10.1038/s41372-020-0733-y

A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

Elisha M Wachman et al. J Perinatol. 2020 Oct.

. 2020 Oct;40(10):1560-1569.

doi: 10.1038/s41372-020-0733-y. Epub 2020 Jul 16.

Authors

Affiliations

¹ Department of Pediatrics, Boston Medical Center, Boston, MA, USA. Elisha.Wachman@bmc.org.
² Newborn Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA.
³ Center for Applied Pediatric Quality Analytics, Children's Hospital Boston, Boston, MA, USA.
⁴ Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
⁵ Department of Pediatrics, Lowell General Hospital, Boston, MA, USA.
⁶ Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA.
⁷ Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA.
⁸ South Shore Hospital, Weymouth, MA, USA.
⁹ Cooley Dickinson Hospital, Northampton, MA, USA.
¹⁰ Department of Pediatrics, Mercy Medical Center, Springfield, MA, USA.
¹¹ Milford Regional Medical Center, Milford, MA, USA.
¹² Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
¹³ Department of Neonatology, Boston Children's Hospital, Boston, MA, USA.
¹⁴ Massachusetts Health Policy Commission, Boston, MA, USA.
¹⁵ Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA.
¹⁶ Massachusetts Department of Public Health, Boston, MA, USA.

PMID: 32678314
DOI: 10.1038/s41372-020-0733-y

Abstract

Objective: To support hospitals in the Massachusetts PNQIN collaborative with adoption of the ESC Neonatal Opioid Withdrawal Syndrome (NOWS) Care Tool© and assess NOWS hospitalization outcomes.

Study design: Statewide QI study where 11 hospitals adopted the ESC NOWS Care Tool©. Outcomes of pharmacotherapy and length of hospital stay (LOS) and were compared in Pre- and Post-ESC implementation cohorts. Statistical Process Control (SPC) charts were used to examine changes over time.

Results: The Post-ESC group had lower rates of pharmacotherapy (OR 0.35, 95% CI 0.26, 0.46) with shorter LOS (RR 0.79, 95% CI 0.76, 0.82). The 30-day NOWS readmission rate was 1.2% in the Pre- and 0.4% in the Post-ESC cohort. SPC charts indicate a shift in pharmacotherapy from 54.8 to 35.0% and LOS from 14.2 to 10.9 days Post-ESC.

Conclusions: The ESC NOWS Care Tool was successfully implemented across a state collaborative with improvement in NOWS outcomes without short-term adverse effects.

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References

1. Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and costs of neonatal abstinence syndrome among infants with medicaid: 2004–2014. Pediatrics 2018;141. https://doi.org/10.1542/peds.2017-3520 .
1. Milliren CE, Gupta M, Graham DA, Melvin P, Jorina M, Ozonoff A. Hospital variation in neonatal abstinence syndrome incidence, treatment modalities, resource use, and costs across pediatric hospitals in the United States, 2013 to 2016. Hosp Pediatr. 2018;8:15–20. - DOI
1. Mehta A, Forbes KD, Kuppala VS. Neonatal abstinence syndrome management from prenatal counseling to postdischarge follow-up care: results of a national survey. Hosp Pediatr. 2013;3:317–23. - DOI
1. Tolia VN, Patrick SW, Bennett MM, Murthy K, Sousa J, Smith PB, et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N. Engl J Med. 2015;372:2118–26. - DOI
1. Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015;35:667. - DOI

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A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

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A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

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Abstract

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