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Implementation of ESC QI Initiative in Neonatal Unit Setting and Adaptation During the Pandemic
Sarah Small1, Rachel Pham1, Meghan Turbenson2
1Creighton University School of Medicine, Phoenix, Arizona.
Insights
A quality improvement initiative using the Eat, Sleep, Console (ESC) tool significantly reduced opioid treatment and length of stay for infants with neonatal opioid withdrawal syndrome (NOWS). Gains were sustained despite the COVID-19 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.
Objectives:
To improve outcomes in infants with neonatal opioid withdrawal syndrome (NOWS) admitted to NICU by implementing a quality improvement (QI) initiative incorporating "eat, sleep, console" (ESC) as a withdrawal evaluation tool and promotion of nonpharmacological interventions. Secondarily, we evaluated the impact of the coronavirus disease 2019 pandemic on QI initiative and outcomes.
Methods:
We included infants born ≥ 36 weeks gestation and admitted to NICU with a primary diagnosis of NOWS between December 2017 and February 2021. (preintervention; December 2017-January 2019, postintervention; February 2019-February 2021). We compared cumulative dose, duration of opioid treatment, and length of stay (LOS) as our primary outcomes.
Results:
The average duration of opioid treatment decreased from 18.6 days in the preimplementation cohort (n = 36) to 1.5 days in the first-year postimplementation (n = 44) with a reduction in cumulative opioid dose from 5.8 mg/kg to 0.6 mg/kg and decrease in the proportion of infants treated with opioids from 94.2% to 41.1%. Similarly, the average LOS decreased from 26.6 to 7.6 days. In the second-year postimplementation during the coronavirus disease 2019 pandemic (n = 24), there was an increase in average opioid treatment duration and LOS to 5.1 and 12.3 days respectively, but cumulative opioid dose (0.8 mg/kg) remained significantly lower than the preimplementation cohort.
Conclusions:
ESC-based quality improvement initiative led to a significant decrease in LOS and opioid pharmacotherapy in infants with NOWS in NICU setting. Despite the impact of the pandemic, some of the gains were sustained with adaptation to ESC QI initiative.
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