A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

Elisha M Wachman; Mary Houghton; Patrice Melvin; Breanna C Isley; Jennifer Murzycki; Rachana Singh; Susan Minear; Kathryn Dee L MacMillan; Debra Banville; Amy Walker; Teresa Mitchell; Rose Galimi-Hayes; Selena Jorgensen; Daphne Remy Gomes; Fran Hodgins; Bonny L Whalen; Hafsatou Diop; Munish Gupta

doi:10.1038/s41372-020-0733-y

A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative

J Perinatol. 2020 Oct;40(10):1560-1569. doi: 10.1038/s41372-020-0733-y. Epub 2020 Jul 16.

Authors

Elisha M Wachman¹, Mary Houghton², Patrice Melvin³, Breanna C Isley⁴, Jennifer Murzycki⁵, Rachana Singh⁶, Susan Minear⁴, Kathryn Dee L MacMillan⁷, Debra Banville⁸, Amy Walker⁹, Teresa Mitchell¹⁰, Rose Galimi-Hayes¹¹, Selena Jorgensen¹², Daphne Remy Gomes¹³, Fran Hodgins¹⁴, Bonny L Whalen¹⁵, Hafsatou Diop¹⁶, Munish Gupta²

Affiliations

¹ Department of Pediatrics, Boston Medical Center, Boston, MA, USA. Elisha.Wachman@bmc.org.
² Newborn Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA.
³ Center for Applied Pediatric Quality Analytics, Children's Hospital Boston, Boston, MA, USA.
⁴ Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
⁵ Department of Pediatrics, Lowell General Hospital, Boston, MA, USA.
⁶ Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA.
⁷ Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA.
⁸ South Shore Hospital, Weymouth, MA, USA.
⁹ Cooley Dickinson Hospital, Northampton, MA, USA.
¹⁰ Department of Pediatrics, Mercy Medical Center, Springfield, MA, USA.
¹¹ Milford Regional Medical Center, Milford, MA, USA.
¹² Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
¹³ Department of Neonatology, Boston Children's Hospital, Boston, MA, USA.
¹⁴ Massachusetts Health Policy Commission, Boston, MA, USA.
¹⁵ Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA.
¹⁶ Massachusetts Department of Public Health, Boston, MA, USA.

PMID: 32678314
DOI: 10.1038/s41372-020-0733-y

Abstract

Objective: To support hospitals in the Massachusetts PNQIN collaborative with adoption of the ESC Neonatal Opioid Withdrawal Syndrome (NOWS) Care Tool© and assess NOWS hospitalization outcomes.

Study design: Statewide QI study where 11 hospitals adopted the ESC NOWS Care Tool©. Outcomes of pharmacotherapy and length of hospital stay (LOS) and were compared in Pre- and Post-ESC implementation cohorts. Statistical Process Control (SPC) charts were used to examine changes over time.

Results: The Post-ESC group had lower rates of pharmacotherapy (OR 0.35, 95% CI 0.26, 0.46) with shorter LOS (RR 0.79, 95% CI 0.76, 0.82). The 30-day NOWS readmission rate was 1.2% in the Pre- and 0.4% in the Post-ESC cohort. SPC charts indicate a shift in pharmacotherapy from 54.8 to 35.0% and LOS from 14.2 to 10.9 days Post-ESC.

Conclusions: The ESC NOWS Care Tool was successfully implemented across a state collaborative with improvement in NOWS outcomes without short-term adverse effects.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Analgesics, Opioid* / therapeutic use
Humans
Infant, Newborn
Length of Stay
Neonatal Abstinence Syndrome* / drug therapy
Quality Improvement
Sleep

Substances

Analgesics, Opioid