Wombmates to Roommates: Rooming-In to Manage Infant Withdrawal

In recent years, opioid use during pregnancy has grown as fast as that in the general population. The state of Utah's rate of Neonatal Opioid Withdrawal Syndrome (NOWS) has increased from 2.5/1000 births in 2009 to 6.4/1000 births in 2017. Nationally, the average length of stay for a NOWS newborn is 23 days at a cost of $94,000 in the Neonatal Intensive Care Unit compared to a healthy newborn's stay of 2 days at $1900. The purpose of this project was to implement "rooming-in" which is keeping the newborn with the mother to provide comprehensive NOWS care for the newborn. In this quality improvement initiative, rooming-in was implemented for 24 newborns with NOWS meeting specific criteria. Their length of stay and medications administered were evaluated and compared to 20 newborns with NOWS cared for in the Intermediate Care Unit (ICN). Parent satisfaction surveys were collected for those that participated in rooming-in and nurse surveys were collected for those that cared for the rooming-in newborns. Rooming-in newborns were admitted for an average of 7 days and received an average of 10 doses of medications. Newborns cared for in the ICN were admitted for an average of 11 days and received an average of 32 doses of medications. The ICN stay was 1.93-6.52 days longer than the rooming-in stay. The average cost per patient stay for the rooming-in newborn was $9552 compared to $21,014 for ICN care. The average cost savings per patient was $11,462. The nurses and parents who participated in rooming-in expressed overall high satisfaction with the process.

Wombmates to Roommates: Rooming-In to Manage Infant Withdrawal Kimberly Meyer, DNP, RNC, NE-BC, Nursing Director; Bhanu Muniyappa, MD, Associate Pediatric Medical Director and Sarah Lauer, MS, RNC-ONQS, Senior Quality Consultant Outcomes Background What Worked Well Prevalence and costs associated with newborn exposure to opioids in utero has increased on national, state, and local levels. • OB/MFM, Pediatrics, Nursing, & Social Work collaboration • National average stay is 23 days ($93,000) compared to a healthy newborn stay of 2 days ($1,900) at University of Utah Health • Utah’s rate of Neonatal Opiate Withdrawal Syndrome (NOWS) increased from 2.5 to 6.4 per 1,000 births (2009 to 2017) • 2019 - 3.6% of newborns diagnosed with NOWS at University of Utah Health Parental Feedback Learning Objectives Nursing Feedback • Partnership with Utah Department of Health “Care was always made a priority and I was reassured of safety.” “Rooming-in with baby going through withdrawal led to sleepless nights.” “Medical team and staff were amazing.” • Describe the potential benefits of rooming-in for both mom and baby. • Outline the components of implementing a rooming-in practice change. “Baby seemed calmer due to skin to skin.” “I have noticed babies who room in cry less, eat better, and have lower NWI scores.” “I feel like babies aren’t getting treated adequately with meds because parents downplay the babies Goals • Evaluate impact of rooming-in on LOS and medication usage withdrawal symptoms.” Limitations • Support outcome measures included in the Opioid Use Disorder Safety Bundle • Maternal antenatal drug use not analyzed to • Greater support to moms caring for newborn with NOWS determine the severity of NOWS symptoms • Not all patients met inclusion criteria Changes Implemented • • • • • • • Rooming-in protocol Provider & staff education Patient exclusion/inclusion criteria Parental Agreement Dyads placed in maternal room vs. ICN Neonatal Withdrawal Inventory for scoring Patient and nurse satisfaction surveys Conclusion • Rooming-in was associated with decreased costs, reduced pharmacological needs, and shorter length of stay. The authors have no relevant financial relationships to disclose. • Successful rooming-in pilot now transitioned to standard practice Authors contact information: [e-mail], [e-mail] and [e-mail] Wombmates to Roommates: Rooming-In to Manage Infant Withdrawal Criteria for eligibility to participate in Rooming-In • Demonstrates consistent follow-up for >30 days in prenatal care • No evidence of opioid or other controlled substance misuse • Documented prenatal education, pediatric and social work consultation before delivery • Educated on expectation of having a consistent support person present for duration of admission • Mother agrees to stay with infant to facilitate universal supportive care for NOWS • Parental agreement signed • There is not a court hold on the infant from Division of Child and Family Services • Mother is not incarcerated The authors of the poster have nothing to disclose Wombmates to Roommates: Rooming-In to Manage Infant Withdrawal References Jones, H. E., Heil, S. H., Baewert, A., Arria, A. M., Kaltenbach, K., Martin, P. R., Coyle, M. G., Selby, P., Stine, S. M., & Fischer, G. (2012). Buprenorphine treatment of opioid-dependent pregnant women: A comprehensive review. Addiction, 107, 5–27. https://doi.org/10.1111/j.1360-0443.2012.04035.x MacMillan, K., Rendon, C., Verma, K., Riblet, N., Washer, D., & Holmes, A. (2018). Association of rooming-in with outcomes for neonatal abstinence syndrome: A systematic review and meta-analysis. Journal of the American Medical Association Pediatrics, 712(4), 345–351. https://doi.org/10.1001/jamapediatrics.2017.5195 NAS among newborn hospitalizations - hcup fast stats. (2019). Agency for Healthcare Research and Quality. https://www.hcup-us.ahrq.gov/faststats/NASServlet?setting1=IP&location1=UT University of Utah [paper presentation]. (2020, March 5–6). AIM Safety Bundle Kick-Off, Salt Lake City, Utah Wachman, E. M., Minear, S., Hirashima, M., Hansbury, A., Hutton, E., Shrestha, H., Combs, G., Barry, K., Slater, C., Stickney, D., & Walley, A. Y. (2019). Standard fixed-schedule methadone taper versus symptomtriggered methadone approach for treatment of neonatal opioid withdrawal syndrome. Hospital Pediatrics, 9(8), 576–584. https://doi.org/10.1542/hpeds.2018-0165 The authors of the poster have nothing to disclose