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Beyond the Mother Baby Dyad

The Hospital Caregiver’s Safety Net
General Meeting
September 12, 2018
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Reduce nursing burnout and improve
patient safety and family satisfaction:
Nursing staff caring for neonates who
have neonatal abstinence syndrome
and their families
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Initiative Background
• NAS will continue to require
nursing care

• Without specialized knowledge to
interact therapeutically with
neonates and their parents with
opioid use disorder, nurses are at
risk for burnout

• Burnout is widespread among
healthcare providers and is
associated with adverse safety
behaviors, operational and clinical
FIGURE 1. National prevalence of opioid use disorder per 1,000 delivery hospitalizations* — National Inpatient Sample (NIS),† Healthcare Cost and Utilization Project (HCUP),
United States, 1999–2014 Maguire D, et al., Advances in Neonatal Care. 2012;12(5): 281–285
* Prevalence numerator consisted of cases of opioid type dependence and nondependent opioid abuse based on International Classification of Diseases, Ninth Revision (ICD-9)
codes (304.00–304.03, 304.70–304.73, 305.50–305.53), and denominator consisted of delivery hospitalization discharges.
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Burnout May Harm the Patient and
Family’s hospital experience
• One of the [NICU] nurses [scored my daughter] higher than the [others], eventually I got mad at
her. I said, “She’s not a junkie baby. She’s a real baby. There’s a real baby there…” Surely, not
everything my child does [is] withdrawal. I told the doctor, “Let somebody else come and give her
the scale thing. And if it’s higher, then you can give her the medicine.” And it wasn’t higher… I was
right! Not everybody was like that… there were a lot of good nurses… But that [nurse] saw me like
that. For some people, that would make them relapse. I can see that being like, ‘well, if you’re
gonna treat me like a junkie, I’m gonna be a junkie…’ because I used to have that mentality. [Now] I
had people that loved me and [told me] that it didn’t matter. What if [someone] doesn’t [have
• - Sarah

• Hospital experiences, as reported in interviews
• Perceived judgmental treatment in L&D, Mother/Baby, NICU
• (e.g., arbitrary & inconsistent Finnegan scoring; questioning/criticizing use of BUP) 11/11
• Moms’ buprenorphine dosing disrupted or delayed in hospital (L&D; Mother-Baby) 4/11
• Said “that one nurse;” described specific nurses’ judgmental treatment 6/11 postpartum
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Initiative Aim

• Goals:
– Reduce nursing burnout ratings by 20% from baseline
– Improve perception of safety ratings by 20% from baseline
– Improve family satisfaction with care ratings by 20% from

• Best practice aims:
– Addiction education and behavioral tools
– Debrief opportunities
– Staff driven support mechanisms
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Initiative Reach
• Target population
– Nursing staff providing care to neonates with NAS
– Caregivers of children receiving care for NAS

• Target facilities
• Hospitals participating in PQCNC
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Initiative Impact
Reduce nursing burnout
Improve nursing well being
Improve safety
Improve family satisfaction
Promotion of patient and family partnership
The spread of best practice

Model of care for the nation
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Initiative Challenges / Barriers
– For training by hospital entities
– For providing support and de-briefing
– For completing surveys

• Stigma, discrimination, and prejudice
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Supporting Materials
1. Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of Neonatal Abstinence Syndrome —
28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65:799–802. DOI:
2. Maguire D, Webb M, Passmore D, Cline G. NICU nurses' lived experience: caring for infants with
neonatal abstinence syndrome. Adv Neonatal Care. 2012 Oct;12(5):281-5
3. Murphy-Oikonen J, Brownlee K, Montelpare W, Gerlach K. The Experiences of Nurses in Caring for
Infants with Neonatal Substance Use Disorder. Academy of Neonatal Nursing. 2010;29(5):307-313. Accessed 2018.
4. Nolte AGW, Downing C, Temane A, Hastings‐Tolsma M. Compassion fatigue in nurses: A metasynthesis. J
Clin Nurs. 2017;26:4364–4378.
5. Ostrach & Leiner 2018. Research Brief: Experiences of perinatal substance use treatment in Western
North Carolina. Distributed at Ethical Considerations in Opioids Conference, Asheville, NC. (publication
6. Profit J, Sharek PJ, Amspoker AB, Kowalkowski MA, Nisbet CC, Thomas EJ, Chadwick WA, Sexton JB.
Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf. 2014 Oct;23(10):806-13.