title: Neonatal abstinence syndrome: evaluating the effectiveness of an evidence-based multidisciplinary care approach.
abstract: An evidence-based, multidisciplinary neonatal abstinence syndrome protocol was developed using a stepwise continuous quality improvement (CQI) approach with the goal of standardizing care procedures for these infants. A retrospective secondary data analysis was performed to evaluate the differential effects of each step of the CQI project on 4 key clinical outcome measures: length of stay (total and post-opioid wean), weaning time from opioids, and use of adjunct medications. Data were analyzed from 386 newborn infants with a diagnosis of neonatal abstinence syndrome undergoing treatment in a level III neonatal intensive care unit. After implementation of a pharmacologic weaning protocol as a foundational first step of the CQI project, the weaning time from opioids remained stable throughout each of the subsequent CQI steps (P = .905). The overall total neonatal intensive care unit length of stay was reduced by 10.35 days (P = .002), and the length of neonatal intensive care unit stay after completing wean from opioids was reduced by 2.79 days (P < .001). Use of adjunct medications also decreased from 30.1% of infants at the initiation of the CQI project to 24.5% at the completion of the project (P = .020). These findings indicate that this multidisciplinary treatment approach led to an overall improved efficiency of both opioid weaning and symptom management for these infants.
authors: Pediatrix Medical Group (Mss Saunders and Cook and Dr Buchheit), East Tennessee Children's Hospital, Knoxville (Mss Saunders, Smith, Cook, and Edds and Drs King and Buchheit); and The University of Tennessee, Knoxville, College of Nursing (Dr Mefford).
authors: Carla
authors: C
authors: Saunders
authors: Terry
authors: T
authors: King
authors: Sheri
authors: S
authors: Smith
authors: John
authors: J
authors: Buchheit
authors: Kyle
authors: K
authors: Cook
authors: Jill
authors: J
authors: Edds
authors: Linda
authors: L
authors: Mefford
mesh_terms: D002985:Clinical Protocols; D019468:Disease Management; D055318:Evidence-Based Nursing / Q000379:methods / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000451:nursing / Q000628:therapy; D017283:Neonatal Nursing / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States