| Description |
Background: Opioid use in pregnant women has increased in recent years, leading to a 48% increase in number of infants diagnosed with neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) (Anbalagan et al., 2024). Current NOWS treatment consists of using the neonatal withdrawal inventory (NWI), which directs pharmacologic management based on signs of withdrawal. Pharmacologic treatment can lead to a prolonged length of stay (LOS), relying on a medication-weaning protocol to guide discharge eligibility. Many facilities are having success after implementing the Eat, Sleep, Console (ESC) method of treatment for NOWS, with decreased LOS and reduced morphine use. Local Problem: A Women and Newborn Department of a community hospital in an urban area of the Intermountain West desires to use an evidence-based method of NOWS treatment. Methods: A team consisting of stakeholders in the Women and Newborn service line created an implementation plan within the NICU, Pediatric, and Mom/Baby units to adopt the ESC method for treatment of NOWS. Interventions: Key stakeholders within the Women and Newborn service line performed a literature review, which identified a predominant support for the ESC treatment method. We conducted a retrospective chart review for infants with NOWS. The team administered a pre-intervention staff survey to identify staff attitudes, satisfaction of current NOWS treatment, and potential barriers for implementing ESC. After compiling survey results, the team created plans to address the possible barriers. The team then created multimodal educational materials and distributed them to staff in preparation for implementation. An executive summary was created using the Situation, Background, Assessment, and Recommendation (SBAR) framework. Results: We performed a retrospective chart review of 140 infants with NOWS from 2020 to 2024 and discovered an average hospital LOS of 18 days (2-102) and an average morphine count of 28.5 doses (0-266). We distributed a pre-intervention survey to 183 staff and providers working within the Women and Newborn service line at the project site facility, each of whom received the pre-intervention survey link by email. Of those, 46 (25.1%) completed the survey, with the majority being from the NICU (n=33, 71.7%). The breakdown of respondents were registered nurses (n=31, 67.4%), advanced practice providers (n=6, 13%), management/shared leaders/educators (n=4, 8.7%), ancillary staff (n=2, 4.3%), and patient care technicians (n=2, 4.3%). The survey respondents listed the following as the most likely potential barriers to implementing the ESC method at the project site facility: lack of parental involvement (n=44, 95.7%), lack of staff buy-in (n=27, 58.7%), and lack of staff education (n=18, 39.1%). Conclusion: The ESC model of NOWS treatment is a well-supported, evidence-based approach for this population. Facilities using this method have seen a decrease in hospital LOS and a reduction in morphine exposure without an increase in readmission. The successful implementation of ESC will depend on encouraging parent involvement, addressing potential barriers, and evaluating the method's usability, feasibility, and satisfaction. |
