In the midst of the current opioid epidemic, Florida hospital teams continue to merge evidence, compassion, and action to improve the quality of care for infants with Neonatal Abstinence Syndrome (NAS). On September 20, 2019, thirty-three Florida NICUs convened for the FPQC Neonatal Abstinence Syndrome (NAS) Initiative Mid-Project Meeting at Second Harvest Food Bank in Orlando.

NAS Initiative hospitals, managed care providers, and state and community organizations were welcomed by the FPQC NAS Initiative leadership and staff. Teams were congratulated for their key driver successes, including improved compliance with the nonpharmacologic treatment and safe discharge bundles.

Hospitals continue to work to increase the number of days caregivers room-in with their infants, improve caregiver survey response rates, and increase compliance with the safe discharge bundle, including increasing referrals to Healthy Start and Early Steps.

Dr. Holly Hills, Associate Professor of Mental Health Law and Policy at the University of South Florida and a licensed clinical psychologist, gave a presentation on trauma-informed care. Participants were reminded of the high incidence of co-morbid post-traumatic stress disorder and trauma amongst mothers with substance use disorder.

It was reiterated that “you don’t have to be a therapist to be therapeutic”; and clinical teams can support mothers who have endured trauma by offering praise for incremental change, modeling problem solving skills, choosing language that is supportive, and creating an atmosphere of respect and acceptance.

Attendees broke out into smaller groups for the Round Robin Session to discuss successes, challenges, and recommendations on five topic areas: medication weaning, inter-rater reliability, caregiver surveys, Healthy Start/Early Steps referrals, and rooming-in. The teams were eager to take the lessons learned back to their hospitals.  

After a networking lunch, the NAS clinical leads, Maya Balakrishnan and Karen Fugate, reviewed the benefits of the Eat, Sleep, Console (ESC) scoring tool. Across the country, state perinatal quality collaboratives implementing ESC have seen improved outcomes for NAS infants; including improved family involvement, efficiency (lowered length of stay and cost), and reliability of scoring. FPQC will be offering limited-space ESC workshops to the NAS Initiative teams in December.

Representatives from Tampa-based DACCO highlighted the perspective of a mother navigating medication-assisted treatment. The mother was candid and insightful when discussing her first-hand experiences and pathway to recovery.

Finally, the teams reviewed Plan, Do, Study, Act (PDSA) cycles to develop and document tests of change, and selected a focus area to work through. Teams were reminded to scale down the scope of tests, pick willing volunteers, select changes that do not take long to gain approval, not reinvent the wheel, and pick easy changes with good yield. These concepts are also covered in the comprehensive FPQC-sponsored QI Bootcamp. Contact FPQC if you are interested in bringing the QI Bootcamp to your hospital.

Teams left the meeting reenergized for the second half of the NAS Initiative. To follow the NAS Initiative, access the toolbox, and learn more about upcoming opportunities, please visit the NAS Initiative page.

In an effort to improve care for mothers with substance use disorder, FPQC will be kicking off the Maternal Opioid Recovery Effort (MORE) on November 14, 2019. Information about the initiative can be found here.