Michele C Walsh1,2, Moira Crowley3,2, Scott Wexelblatt4,5, Susan Ford3, Pierce Kuhnell6, Heather C Kaplan4,5, Richard McClead7,8, Maurizio Macaluso4,5, Carole Lannon4,5. 1. Division of Neonatology and Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio; michele.walsh@uhhospitals.org. 2. Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio. 3. Division of Neonatology and Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, Ohio. 4. Anderson Center for Health Systems Excellence and. 5. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio. 6. Division of Biostatistics and Epidemiology, Cincinnati Children's Medical Center, Cincinnati, Ohio. 7. Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and. 8. Department of Pediatrics, Ohio State University, Columbus, Ohio.
Abstract
OBJECTIVES: Neonatal abstinence syndrome (NAS) after an infant's in-utero exposure to opioids has increased dramatically in incidence. No treatment standards exist, leading to substantial variations in practice, degree of opioid exposure, and hospital length of stay. METHODS: The Ohio Perinatal Quality Collaborative conducted an extensive multi-modal quality improvement initiative with the goal to (1) standardize identification, nonpharmacologic and pharmacologic treatment in level-2 and 3 NICUs in Ohio, (2) reduce the use of and length of treatment with opioids, and (3) reduce hospital length of stay in pharmacologically treated newborns with NAS. RESULTS: Fifty-two of 54 (96%) Ohio NICUs participated in the collaborative. Compliance with the nonpharmacologic bundle improved from 37% to 59%, and the pharmacologic bundle improved from 59% to 68%. Forty-eight percent of the 3266 opioid-exposed infants received pharmacologic treatment of symptoms of NAS, and this rate did not change significantly across the time period. Regardless of the opioid used to pharmacologically treat infants with NAS, the length of treatment decreased from 13.4 to 12.0 days, and length of stay decreased from 18.3 to 17 days. CONCLUSIONS: Standardized approaches to the identification and nonpharmacologic and pharmacologic care were associated with a reduced length of opioid exposure and hospital stay in a large statewide collaborative. Other states and institutions treating opioid-exposed infants may benefit from the adoption of these practices.
OBJECTIVES:Neonatal abstinence syndrome (NAS) after an infant's in-utero exposure to opioids has increased dramatically in incidence. No treatment standards exist, leading to substantial variations in practice, degree of opioid exposure, and hospital length of stay. METHODS: The Ohio Perinatal Quality Collaborative conducted an extensive multi-modal quality improvement initiative with the goal to (1) standardize identification, nonpharmacologic and pharmacologic treatment in level-2 and 3 NICUs in Ohio, (2) reduce the use of and length of treatment with opioids, and (3) reduce hospital length of stay in pharmacologically treated newborns with NAS. RESULTS: Fifty-two of 54 (96%) Ohio NICUs participated in the collaborative. Compliance with the nonpharmacologic bundle improved from 37% to 59%, and the pharmacologic bundle improved from 59% to 68%. Forty-eight percent of the 3266 opioid-exposed infants received pharmacologic treatment of symptoms of NAS, and this rate did not change significantly across the time period. Regardless of the opioid used to pharmacologically treat infants with NAS, the length of treatment decreased from 13.4 to 12.0 days, and length of stay decreased from 18.3 to 17 days. CONCLUSIONS: Standardized approaches to the identification and nonpharmacologic and pharmacologic care were associated with a reduced length of opioid exposure and hospital stay in a large statewide collaborative. Other states and institutions treating opioid-exposed infants may benefit from the adoption of these practices.
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Authors: Susan Ford; Leslie Clarke; Michele C Walsh; Pierce Kuhnell; Maurizio Macaluso; Moira Crowley; Richard McClead; Scott Wexelblatt; Carole Lannon; Heather C Kaplan Journal: Pediatr Qual Saf Date: 2021-08-26