Non-Pharmacological Nursing Care Guideline for Newborns with NAS in the Level III NICU: A Quality Improvement Project

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs in newborns that are exposed to substances of abuse while in utero producing behavioral and physiological signs and symptoms. These addictive substances can include maternal prescription use or illicit drug use. Infant symptoms of withdrawal occur shortly following birth and can appear anywhere from 1 to 10 days after birth. The number of infants born with NAS has quadrupled and severity of withdrawal symptoms has increased, causing many newborns with NAS to be admitted to the newborn intensive care unit. Newborns with NAS experience longer and often medically complex and costly hospitalizations. Due to the wide variations in the non-pharmacologic nursing care delivered to these extremely complex infants with NAS, standardizing the approach to nursing care in a local Level III NICU is essential. An initial literature review was conducted to identify best nursing practice to improve outcomes of infants with neonatal abstinence syndrome. The aim of this project is to create an evidence-based guideline to provide a standardized approach to non-pharmacological supportive care for newborns with NAS. Benefits of non-pharmacologic intervention include: decreasing environmental stimuli, promoting feeding and nutrition, and promoting adequate rest and sleep. This scholarly project focuses on the creation of an evidence-based guideline for the non-pharmacologic management for newborns suffering from neonatal abstinence syndrome (NAS) within a local level III newborn intensive care unit. The objectives of this DNP project are to: (1) explore prevailing attitudes of NICU staff regarding current care of newborns with NAS; (2) develop a non-pharmacological clinical practice guideline (CPG) for the care of newborns with NAS within a level III NICU; (3) communicate the non-pharmacological CPG to staff and parents at the implementation site; and (4) present the clinical guideline to the Intermountain Health Care Corporation Development Team. A survey exploring the attitudes and practices of the IMC NICU staff was sent to staff regarding prevailing attitudes, available resources and practice. The clinical guideline was developed to ensure consistency in care of newborns with NAS. The guideline provides management and intervention strategies in six categories that include: environmental modifications, positioning, rocking, feeding and nutrition, alternative comfort, and parent/caregiver education. The NICU staff received education regarding the benefits of consistent NAS care practices. The guideline was submitted to IMC in March 2017 and approval for inclusion in department protocols is pending. The non-pharmacological guideline will be incorporated into every newborn's plan of care who are withdrawing from NAS. Non-pharmacological nursing interventions among NICU caregivers will be the first line of care. Increasing awareness of consistent standardized nursing care for newborns withdrawing from NAS that is evidence-based may result in reduced hospital stays, decreased cost, and improved overall outcomes.