Interobserver Reliability of the Finnegan Neonatal Abstinence Scoring Tool in an Acute Care Setting

Abstract

Poster Presentation Objective To determine if interobserver reliability of the Finnegan Neonatal Abstinence Scoring Tool (FNAST) exists among nurses who care for infants with neonatal abstinence syndrome (NAS) in the neonatal intensive care unit (NICU), mother/baby unit, and pediatric/pediatric intensive care unit (PEDS/PICU) of a regional tertiary hospital. Design A cross-sectional, interobserver reliability study of the Finnegan scoring tool. Sample A convenience sample of 122 nurses in a regional tertiary hospital yielded 10 nurses from NICU, 65 nurses from mother/baby, and 47 nurses from PEDS/PICU. Institutional Review Board approval was obtained before this study. Methods Participants were asked to complete a demographic survey that provided information on primary unit of practice, education level, years of experience, and certifications. A video vignette of an assessment of an infant with NAS, which is part of an interobserver reliability program developed by D'Apolito and Finnegan, was used with permission. After viewing the video, participants completed the FNAST based on their observations and assessments. Implementation Strategies Not applicable. Results The expert rater score of the vignette used for this study was 13. The overall median total score for participants was 12.76 with a standard deviation of 3.306. The interclass correlation coefficient (ICC) relative to average measures calculated to determine the reliability of the participants' total scores was excellent at 0.996. The ICC relative to single measures or how the score was obtained did not demonstrate reliability at 0.694. The area of greatest discrepancy was noted within the central nervous system portion of the scoring tool. Demographic data indicated that 58% of participants had Bachelor of Science in nursing degrees; 54% had 0 to 5 years of experience; and 46% were certified in their specialty areas. Conclusion/Implications for Nursing Practice Interobserver reliability was established for total score. Interobserver reliability was not established for single measures with the majority of the discrepancies found within the central nervous system portion of the FNAST. If clinical decisions are made based on the reliability of these scores, values should be a minimum of 0.90. Going forward, education in Finnegan scoring should have an increased focus on the central nervous system portion of the scoring tool. We also recommend that interobserver reliability of the FNAST should be part of annual competencies and included in orientation for new nurses on the NICU, mother/baby unit, and PEDS/PICU due to the epidemiology of NAS.