Implementation of ESC QI Initiative in Neonatal Unit Setting and Adaptation During the Pandemic

Area of Science:

• Neonatal Medicine
• Quality Improvement Science
• Pharmacology

Background:

• Neonatal Opioid Withdrawal Syndrome (NOWS) presents significant challenges in Neonatal Intensive Care Units (NICUs).
• Traditional management often involves prolonged opioid pharmacotherapy and extended hospital stays.
• There is a need for effective, non-pharmacological approaches to manage NOWS.

Purpose of the Study:

• To implement and evaluate a quality improvement (QI) initiative using the Eat, Sleep, Console (ESC) tool for infants with NOWS.
• To reduce opioid treatment duration, cumulative opioid dose, and length of stay (LOS) in infants with NOWS.
• To assess the impact of the COVID-19 pandemic on the QI initiative and patient outcomes.

Main Methods:

• A retrospective study of infants born ≥ 36 weeks gestation diagnosed with NOWS and admitted to the NICU.
• Comparison of outcomes between preimplementation (December 2017-January 2019) and postimplementation (February 2019-February 2021) cohorts.
• Evaluation of primary outcomes including cumulative opioid dose, duration of opioid treatment, and LOS.

Main Results:

• The ESC-based QI initiative led to a significant decrease in average opioid treatment duration (18.6 to 1.5 days) and LOS (26.6 to 7.6 days) in the first year postimplementation.
• Cumulative opioid dose decreased from 5.8 mg/kg to 0.6 mg/kg, with a reduction in infants receiving opioids from 94.2% to 41.1%.
• During the COVID-19 pandemic, there was a slight increase in treatment duration and LOS, but outcomes remained significantly improved compared to preimplementation.

Conclusions:

• The ESC-based QI initiative effectively reduced LOS and opioid pharmacotherapy for infants with NOWS in the NICU.
• The initiative demonstrated adaptability, with sustained improvements despite the challenges posed by the COVID-19 pandemic.
• The ESC tool is a valuable component of non-pharmacological strategies for managing NOWS.