A Clinical Practice Guideline Promoting Opioid Awareness in a Level IV NICU

Problem. Neonates may be exposed to significant amounts of opioids in the NICU. The objective of this project was to investigate opioid exposure of neonates in a level IV NICU, enhance provider knowledge of this problem through education, and develop a clinical practice guideline to promote increased opioid awareness and more effective monitoring of therapy in neonates. Methods. This project explored neonatal opioid exposure in a level IV NICU via a retrospective chart review. Neonates classified as high users of opioids were included in the chart review. A systematic review of literature guided the construction of an evidence-based clinical practice guideline (CPG) to reduce opioid exposure in neonates. A pre- and post-survey was conducted to assess the participants learning after the presentation of the guideline. Input from NICU stakeholders was elicited on a working draft of the CPG. A final draft of the CPG was submitted for institutional approval. Results. The amount of opioids received from admission to discharge in IV morphine milligram equivalents (MME) revealed a median of 19.7 MME. The median number of days that neonates received opioids was 20 days. Post-test results following presentation of the CPG and chart review data demonstrated significant change in 2 of 6 pre-survey questions: (1) participants believed there is an increased use of opioids in the NICU (P=0.004) and (2) participants considered the effects of opioids when prescribing or administering them (P=0.006). Conclusions. Most neonates were found to have significant opioid exposure in the charts reviewed. Following presentations of the data and CPG, learning was observed among participants. A CPG that enhances providers' opioid awareness, prescribing and management, and surveillance of therapy has the potential to reduce opioid exposure in this population. Further study will need to be conducted following approval and implementation of the CPG.