Implementation of eat, sleep, console for Neonatal Opioid Withdrawal Syndrome (NOWS): A quality improvement project

Abstract

BackgroundThe opioid abuse crisis has caused a 6-fold increased incidence of neonatal opioid withdrawal syndrome (NOWS) from 2000 to 2017. The Finnegan Neonatal Abstinence Scoring System (FNASS) has been used to score withdrawal symptoms since 1975. New research using the Eat, Sleep, Console (ESC) assessment and model of care has improved the care of infants with in-utero exposure to opioids. MethodsThe QI project at 2 hospitals compared 12 months of retrospective data to a prospective 12-month trial of ESC implementation. One hospital also compared ESC and FNASS simultaneously. Nurses and providers received training and education. ResultsIn the baseline period, 142 infants were scored for withdrawal, with an ALOS of 7.6 days, an average NICU LOS of 118.7 h (4.9 days), and 32 required pharmacologic treatment with an average length of treatment of 369.8 h (15.4 days). In the study period, 142 were assessed for withdrawal, with a decreased ALOS of 6.5 days (p = 0.2287), a decreased NICU LOS of 89.6 h (p = 0.2295), and 10 required pharmacologic treatment (p = 0.00024) with an increased average length of treatment of 387.3 h (p = 0.8609). Out of 71 infants assessed simultaneously with FNASS and ESC, 37 had FNASS scores that met the threshold for pharmacologic treatment, and only 6 infants received pharmacologic treatment. ConclusionImplementation of ESC improves the care of infants and reduces hospital stays and the need for pharmacologic intervention in the management of NOWS. It optimizes the infant's functioning through nonpharmacologic care provided by parent(s) reserving pharmacologic treatment only for those infants unable to eat, sleep, or console.