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Improving Outcomes in Infants With Neonatal Abstinence Syndrome With the Eat, Sleep, Console Method
Sarah Nicholson1, Aksana Waskosky, Debra Moon
1Ascension St Vincent Peyton Manning Children's Hospital, Indianapolis, Indiana (Mss Nicholson and Moon); and University of Indianapolis, Indianapolis, Indiana (Dr Waskosky).
Insights
The Eat, Sleep, Console (ESC) method significantly reduced hospitalization length and morphine use in newborns with Neonatal Abstinence Syndrome (NAS), offering a promising alternative to the Finnegan Neonatal Abstinence Scoring System (FNASS).
Area of Science:
- Neonatal care
- Pharmacology
- Quality improvement science
Background:
- Neonatal Abstinence Syndrome (NAS) presents a significant public health challenge.
- Prolonged hospitalization and medication exposure are key concerns for infants with NAS.
- A quality improvement initiative was undertaken in a neonatal intensive care unit (NICU) to address these issues.
Purpose of the Study:
- To evaluate the efficacy of the Eat, Sleep, Console (ESC) method in reducing length of stay (LOS) and morphine utilization.
- To compare the ESC method with the traditional Finnegan Neonatal Abstinence Scoring System (FNASS) for NAS management.
Main Methods:
- The study included infants with a gestational age of 36 weeks or more exposed to opiates in utero.
- The Finnegan Neonatal Abstinence Scoring System (FNASS) was replaced by the ESC method, emphasizing nonpharmacologic interventions.
- Data were collected for six months pre- and post-implementation for comparative analysis.
Main Results:
- Average LOS decreased by 47%, from 25.9 to 13.7 days.
- Scheduled morphine initiation reduced by 88% (58% to 7%), and as-needed initiation by 79% (33% to 7%).
- Adjunctive medication use decreased by 100% (17% to 0%).
Conclusions:
- The ESC method demonstrated significant improvements in LOS and reduced morphine usage compared to FNASS.
- Findings support the expansion of the ESC program to well newborn populations and similar healthcare settings.
- Further research is warranted to investigate long-term neurodevelopmental outcomes in infants managed with the ESC method.
Background:
Neonatal abstinence syndrome (NAS) is a significant public health concern. A quality improvement project was executed in a neonatal intensive care unit at a large urban hospital. The aim was to address the prolonged hospitalization of infants and exposure to medications to treat NAS.
Purpose:
The goal was to determine whether the eat, sleep, console (ESC) method decreases the length of stay (LOS) and morphine usage when compared with the Finnegan Neonatal Abstinence Scoring System (FNASS).
Methods:
The inclusion criteria were 36 weeks' or longer gestation and exposure to opiates in utero. The FNASS method was replaced by the ESC method with a refocus on nonpharmacologic care. Data were collected for 6 months during implementation of the ESC method and compared with the 6 months prior to implementation.
Results:
The results of the project include: the average LOS decreased from 25.9 days to 13.7 days, a 47% reduction; the rate of scheduled morphine initiation decreased from 58% to 7%, an 88% reduction; as-needed morphine initiation decreased from 33% to 7%, a 79% reduction; and the rate of adjunctive medication initiation decreased from 17% to 0%, a 100% reduction.
Implications For Practice And Research:
The outcomes of LOS and rate of morphine usage were significantly improved when using the ESC method when compared with the FNASS at this facility. The results support future implications including expanding the ESC program to the well newborn population at this facility and other similar units. Further research needs to be done on long-term neurodevelopmental outcomes.
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