Defense Date

7-16-2021

Graduation Date

Summer 8-13-2022

Submission Type

DNP Manuscript

Degree Name

Doctor of Nursing Practice (DNP)

Department

Doctor of Nursing Practice (DNP) Program

School

School of Nursing

Faculty Mentor

Frank Kosnosky

Committee Member

Mary Loughran

Committee Member

Catherine Johnson

Committee Member

Manjulata Evatt

Committee Member

Melanie Turk

Committee Member

Mary Ellen Glasgow

Committee Member

Rosemary Donley

Keywords

neonatal abstinence syndrome, neonatal opioid withdrawal, pregnancy, substance use disorder, opioid addicted newborn, Finnegan Neonatal Abstinence Scoring Tool, Eat Sleep Console Approach

Abstract

Neonatal Opioid Withdrawal Syndrome (NOWS), a subgroup of Neonatal Abstinence Syndrome (NAS), is a constellation of postnatal symptoms that occurs due to the abrupt cessation of intrauterine opioid exposure. Historically, these infants have been evaluated and treated by the Finnegan Neonatal Abstinence Scoring Tool (FNAST) (Appendix A). Recent evidence supports the use of the Eat Sleep Console Approach (ESC) (Appendix B) as an alternative to the FNAST. The ESC model focuses on the comfort and care of these infants by maximizing nonpharmacologic methods and increasing family involvement in the treatment of their infant. The purpose of this project was to evaluate the implementation of ESC in a community hospital and to develop recommendations for subsequent steps to continue the improvement of care for this mother-infant dyad. Clinical data was collected and evaluated on opioid exposed newborns (OENs) from December 2019 through December 2020. ESC was implemented in June of 2020; therefore, we were able to compare six months of infants who were evaluated and treated using FNAST to six months of infants who were evaluated and treated using ESC. Additionally, clinical data was collected and examined to evaluate maternal outcomes that may have been impacted by this change in assessment tools. Lastly, survey data was collected from outpatient pediatric providers to assess their level of comfort in caring for these newborns, assess typical practice in caring for this patient population and evaluate handoff from the inpatient facility. The goals to decrease the average length of stay (ALOS) by one day and total morphine exposure by 20% were met. Other findings include that ESC enhances mother-infant bonding and decreases cost. Additionally, there were inconsistencies identified in outpatient follow up practices and outpatient providers desire consistent handoff from inpatient facilities.

Language

English

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