Improving Care for Infants With Neonatal Abstinence Syndrome: A Multicenter, Community Hospital-Based Study.

Abstract

For infants with neonatal abstinence syndrome (NAS) in children's hospitals, treatment protocols emphasizing nonpharmacologic care have revealed improved hospital outcomes. We sought to improve NAS care within the community hospital setting through the implementation of an Eat, Sleep, Console (ESC) protocol. Using a multidisciplinary quality improvement approach, we implemented an ESC protocol at 2 community hospitals. Primary outcomes were to decrease length of stay (LOS) by 20% and decrease scheduled morphine use to <20%. Balancing measures included transfer to a higher level of care and unplanned 30-day readmissions. Data were extracted over 2 years, from 2017 through 2018. Interventions included an emphasis on nonpharmacologic care, the initiation of 1-time morphine dosing, flexible weaning schedules for infants on morphine, and the use of ESC scoring. Data were analyzed by using statistical process control. A total of 304 NAS patients were admitted from January 2017 to December 2018, with 155 during the postintervention period. After implementation, mean LOS decreased from 9.0 to 6.2 days, and morphine use decreased from 57% to 23%, both with special cause variation. There were 2 unplanned readmissions in the postintervention period compared with 1 preintervention and no transfers to higher level of care in either period. Implementation of a nonpharmacologic care protocol within 2 community hospitals led to significant and sustained improvement in LOS and morphine exposure without compromising safety. In this study, we illustrate that evidence-based practice can be successfully implemented and sustained within community hospitals treating infants with NAS.