Neonatal
Steroids for
women at risk
for preterm
birth
(240/7 - 33
6/7
Done Transition
to BC Surveillance
Spread
to all
maternit
y
hospitals
in Ohio
2014:
Blood
Stream
Infections:
High
reliability
of line
maintenan
ce bundle
Progesterone
to Reduce
Preterm Birth
Risk
Use of
human
milk in
infants
22-29
weeks
GA
2014:
OCHA
NAS in
6 CHs
Neonatal
Abstinence
Syndrome
Tripoint Medical
Center (Lake
Mercy Regional Clevelan
ProMedi
Promedica
Medical Center d Clinic HillcrestHealth)
ca Bay
Toledo
Hospital
Fairview
Lorain
Childrens Mercy Park
Trumbull
Hospital
UH Rainbow
Elyria
Medical
Childrens
Memorial
Center -UH MetroHealthBabies &
Hospital
Blanchard
Mercy
Childrens
Akron Childrens Summa
Valley
Akron
Akron Childrens Medical
OhioHeal
Center
Nationwi
Marion
Childrens
St. Ritas
Lima
th
Canton
de
Genera
St.
Elizabeth
Medical
Memorial
Aultma
MedCent
Riversid
l
Health
Center
Health Nationwide
n
ral
e
Center/Maho
Nationwide Mt. Carmel St.
System
Dublin
Upper
Methodis Mansfiel Anns
ning Valley
Mt.
Carmel West OSU Mt. Carmel
East
Methodist
d
Dayton
Valley
t
Nationwide Doctors
Licking Memorial Health
ChildrensHospital Medical
Springfield Regional
Good Samaritan
System
Center
Nationwide
Medical Center Nationwi
Dayton
Miami
Genesis
Healthcare
de GrantChildrens
Soin Medical Center
Valley
Southview
Medical Center
System
Kettering
Fort
Adena
Cincinnati
Hamilton
Atrium Medical Center
Regional
Childrens
ood
Samaritan
Mercy Hospital Fairfield
Medical
Hospital
Mercy Anderson
Center
UH Cincinnati
Bethesda
The Christ
Southern
Mercy
Health
North
Hospital
Ohio Medical
West
Hospital
Center
1/2014 start Level 3
and Level 2 teams
4/2014 start
Level 2 teams
SMART AIM
By increasing
identification of and
compassionate
withdrawal treatment
for full-term infants
born with Neonatal
Abstinence
Syndrome (NAS), we
will reduce length of
stay by 20% across
participating sites by
June 30, 2015.
KEY DRIVERS
Prenatal Identification of
Mom
Implement Optimal Med Rx
Program
Attain high
reliability in NAS
scoring by
nursing staf
Leader: Walsh
INTERVENTIONS
All MD and RN staff to view Nurture
the Mother- Nurture the Child
Monthly education on addiction care
Importance of Assessment:
what are we assessing?
Neonatal Withdrawal
Onset: 24 hours to days
Duration: 16 days to months, self limiting
13%
80%
70%
42%
42%
Not done
currently
60%
Planned
50%
40%
29%
13%
30%
20%
10%
13%
33%
17%
0%
All fulltime nursing staff in our NICU complete the DAppolito NAS scoring training video
Implementing
Part of our
practice
Improve Consistency in
Modified Finnegan Scoring
All sites use same tool
Train RN staff to 90% reliability
in scoring using
DApolito
Training
System
In Pilot work, we were able to see
drop in max score when training
completed
Finnegan
Scoring Tool
Erin L. Keels MS, APRN, NNP-BC
NAS Taskforce Chair
NNP Program Director
Nationwide Childrens Hospital
Columbus, Ohio
....
....
Modified Finnegan
Assessed from the beginning of one feeding til the beginning of the
next feeding, Q 3-4 hrs
Challenging with breastfed neonates
....
Gastrointestinal
System
Excessive sucking (1)
Poor
feeding (2)
Regurgitation (2)
Projectile
Vomiting (3)
Stools (2-3)
....
....
Ongoing Inter-rater
Reliability
2013 NCH Staff Survey on Finnegan
Scoring:
excoriation
....
Results
....
OPQC Resources
opqc.net
Projects
NAS
Learning Sessions Archives
June
26, 2014 1:10-1:50pm & 1:552:35pm Finnegan Scoring (Keels)
17 minute video of this presentation is
on our website
Study:
Act:
Questions?