An initiative to improve the quality of care of infants with neonatal abstinence syndrome

Abstract

Background and Objectives: The Incidence of Neonatal Abstinence Syndrome, A Constellation of Neurologic, Gastrointest., and Musculoskel. Disturbances Assoc. with Opioid Withdrawal, Has Increased Dramatically and Is Assoc. with Long Hosp. Stays. at Our Inst., the Average Length of Stay for Infants Exposed to Methadone in Utero Was 22.4 Days before the Start of Our Proj.. We Aimed to Reduce ALOS for Infants with NAS by 50%. Methods: in 2010, A Multidisc. Team Began Several Plan-do-Stud.-act Cycles at Yale New Haven Children's Hosp.. Key Interventions Included Standardization of Nonpharmacologic Care Coupled with An Empowering Message to Parents, Devmt. of A Novel Approach to Assess., Admin. of Morphine on An As-needed Basis, and Transf. of Infants Directly to the Inpatient U., Bypassing the NICU. the Outcome Measures Included ALOS, Morphine Use, and Hosp. Costs Using Stat. Proc. Contr. Charts. Results: There Were 287 Infants in Our Proj., Including 55 from the Baseline Period and 44 from the Postimplementation Period . ALOS Decreased from 22.4 to 5.9 Days. Proportions of Methadone-exposed Infants Treated with Morphine Decreased from 98% to 14%; Costs Decreased from 44 824 to 10 289. No Infants Were Readmitted for Treatm. of NAS and No Adverse Events Were Reported. Conclusions: Interventions Focused on Nonpharmacologic Therapies and A Simplified Approach to Assess. for Infants Exposed to Methadone in Utero Led to Both Substantial and Sustained Decreases in ALOS, the Proportion of Infants Treated with Morphine, and Hosp. Costs with No Adverse Events.