Quality improvement initiative to improve inpatient outcomes for Neonatal Abstinence Syndrome

Area of Science:

• Neonatal care
• Pharmacology
• Quality Improvement

Background:

• Neonatal Abstinence Syndrome (NAS) affects opioid-exposed infants.
• Improving inpatient outcomes for these infants is a critical healthcare challenge.
• Current treatment protocols require optimization for better patient and economic results.

Purpose of the Study:

• To enhance Neonatal Abstinence Syndrome (NAS) inpatient outcomes.
• To implement and evaluate a comprehensive quality improvement (QI) program for NAS care.
• To reduce pharmacologic treatment and hospitalization duration for opioid-exposed newborns.

Main Methods:

• Utilized quality improvement (QI) methodology, including stakeholder interviews and plan-do-study-act (PDSA) cycles.
• Implemented a non-pharmacologic care bundle and function-based assessments using the "Eat, Sleep, Console" (ESC) Tool.
• Transitioned pharmacologic treatment to methadone for eligible opioid-exposed infants.

Main Results:

• Reduced pharmacologic treatment from 87.1% to 40.0% and adjunctive agent use from 33.6% to 2.4%.
• Decreased mean hospitalization length from 17.4 to 11.3 days and opioid treatment days from 16.2 to 12.7 days (p < 0.001).
• Increased parental presence from 55.6% to 75.8% (p < 0.0001) with no adverse events.

Conclusions:

• A comprehensive QI program integrating non-pharmacologic care, function-based assessments, and methadone significantly improved NAS outcomes.
• The study demonstrated sustained improvements in key clinical and economic indicators.
• Findings suggest a potential model for improved care practices for opioid-exposed newborns.