title: Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.
abstract: An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS.
  
  
  
  The study included 22 infants having a gestational age of 35-41 weeks, diagnosed with NAS, and discharged for outpatient methadone management. Discharges spanned 10 months and included 3 improvement periods. The outpatient program includes comprehensive discharge planning, a focused electronic health record (EHR) template, management guidelines, and parent and provider education.
  
  
  
  Providers complied with using the outpatient management guideline and EHR template, and assessed weight, NAS symptoms, and methadone dose during appointments. Two infants required NAS-related hospital readmission in the study period. From improvement period 1 to period 3 there was no difference in total outpatient days on methadone (58, 53, 74 days, respectively) or cumulative methadone dose (2.7, 2.6, 3.1mg/kg, respectively). A downward trend pattern in cumulative methadone exposure was noted in improvement period 2. Pre- and postimplementation surveys revealed that after implementation, parents had better understanding of NAS before delivery (71% vs. 100%, p = 0.009), while providers had increased comfort with outpatient management (24% vs. 67%, p < 0.001) and educating parents (48% vs. 82%, p = 0.001).
  
  
  
  This preliminary study suggests that outpatient NAS management can be safe when a comprehensive management program is implemented and can result in provider compliance with the program.
authors.affiliation: Formerly resident, Pediatrics, University of South Florida (USF), Tampa; Pediatrician, Matagorda Episcopal Health Outreach Program's Pediatric Clinic, Bay City, Texas.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Chau
authors.affiliation: USF.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: Assistant Professor, Comparative Effectiveness Research, USF; Assistant Professor, USF Morsani College of Medicine.
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.affiliation: Associate Professor, USF Morsani College of Medicine and the College of Public Health; Division Chief, General Academic Pediatrics and Pediatrics.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: Professor of Pediatrics, USF Morsani College of Medicine; Chief Quality Officer, USF Health.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Ashmeade
authors.affiliation: Associate Professor, Pediatrics, USF Morsani College of Medicine; Medical Director of Quality, Florida Perinatal Quality Collaborative, USF Health, Tampa. Electronic address: mbalakri@health.usf.edu.
authors.forename: Maya
authors.initials: M
authors.lastname: Balakrishnan
mesh_terms: D000046:Academic Medical Centers; D000553:Ambulatory Care / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000628:therapy*; D010045:Outpatients; D010290:Parents / Q000193:education; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement; D016896:Treatment Outcome
chemical_list: D008691:Methadone