Welcome to the OPQC NAS October Action Period Call • Thank you for joining; our webinar will start shortly! • In the mean time; please sign in the chat box with the names of all webinar participants and hospital affiliation.
Welcome! Neonatal Abstinence Syndrome Project October Action Period Call Ohio Perinatal Quality Collaborative October 2015
The line will be placed on Group Mute To ask a question: Click on the Raised Hand icon You can type your question into the Chat Box You can use *6 to come off of GROUP MUTE (and *6 to go back on). 3
Agenda Time Topic Presenter 12:00 pm Welcome & Agenda Review Andrea Hoberman, MPH Learning Session Highlights 12:10 pm Data Overview Heather Kaplan, MD 12:25 pm Phase 2: Andrea Hoberman New Data Measures & Collection Forms Learning Lab Structure for Groups 1-4 12:35 pm New Data SharePoint Functionality Dan Jeffers, MS Team Discussion – Q&A 12:45 pm All teams 12:55 pm Next Steps Andrea Hoberman • Data Submission Reminder • MPR/PDSA Reminder • Learning Lab Calls 4
Learning Session Highlights 5
What one strategy that you heard today will you want to test or implement at your site? (n=66) Formula Info 17 PDSAs 12 Other 10 Reliability 10 Flow Charts 5 Data Collection 4 Finnegan Scoring 3 MCO 3 0 5 10 15 20 6
Key Driver Diagram Project Name: OPQC Neonatal NAS Leader: Walsh INTERVENTIONS KEY DRIVERS All MD and RN staff to view “Nurture GLOBAL AIM Prenatal Identification of Mom the Mother- Nurture the Child” Implement Optimal Med Rx Program Monthly education on addiction care To reduce the number of Improve recognition and non- moms and babies with • Fulltime RN staff at Level 2 and 3 to judgmental support for Narcotic narcotic exposure, and complete D’Apolito NAS scoring training addicted women and infants reduce the need for video and achieve 90% reliability. treatment of NAS. Attain high reliability in NAS Swaddling, low stimulation. scoring by nursing staff Encourage kangaroo care SMART AIM Feed on demand- MBM if appropriate Optimize Non-Pharmacologic Rx or lactose free, 22 cal formula By increasing Bundle identification of and Initiate Rx If NAS score > 8 twice. compassionate Stabilization/ Escalation Phase Standardize NAS Treatment withdrawal treatment for Wean when stable for 48 hrs by 10% Protocol full-term infants born with daily. Neonatal Abstinence Connect with outpatient support Syndrome (NAS), we will Establish agreement with outpatient and treatment program prior to reduce length of stay by 1 program and/or Mental Health discharge day across participating Utilize Early Intervention Services sites by June 30, 2016. Partner with Families to Establish Collaborate with DHS/ CPS to ensure Safety Plan for Infant infant safety. Engage families in Safety Planning. Partner with other stakeholders to influence policy and primary Provide primary prevention materials to prevention. sites.
Collaborative Aggregate Data Submission 8
% Infants that Received ANY Non Pharmacologic Elements Before Drug Treatment 9
% Non Pharmacologic Bundle Compliance 10
Distribution of Non-Pharmacologic Care Elements Received Before Drug Treatment (Purple) 11
% Infants that Received Pharmacologic Treatment 12
% Pharamacologic Bundle Compliance 13
Distribution of Pharmacologic Treatment Elements Received (Pink) 14
Average Length of Opiate Treatment 15
Average Length of Stay for Pharmacologically Treated Babies 16
OPQC NAS Phase 2 Timeline Phase 2 data collection begins with babies born after 10/1/15 July Aug Sept October-June July Learning Session — PROJECT KICK OFF Hospitals commit to participate Analyze Results Sites self select to 1 of 4 formula groups Update & Test & finalize Data Collection Form Implement Best Test & finalize Data Collection Instructions Care Practices Call with Lead Physicians (August) Run OT Testing “Learning Lab” AP Calls Quarterly Action Period Group Calls Data Collection & Submission Continued work on other Key Drivers 17
Orchestrated Testing Measures • Measures that are not changing: – Length of stay for pharmacologically treated infants – Length of opiate treatment for pharmacologically treated infants – Percent of infants treated pharmacologically • Each of these measures will continue on from the beginning of the collaborative with an annotation for the start of the Orchestrated Testing phase 18
Orchestrated Testing Measures • New or redesigned process measures: – Non-pharmacologic bundle compliance • Adding 22 kcal/oz formula for sites that are in groups that are using 22 kcal/oz formula • Only including low lactose feeding for sites that are in groups that are using low lactose formula – Percent of infants receiving low lactose feeding/Percent of infants receiving 22 kcal/oz feeds • New measures for site and Orchestrated Testing group levels – Percent of infants fed breast milk • New measure for all levels 19
Orchestrated Testing Measures • New outcome measures: – Length of stay for all infants • We will now be collecting length of stay for all babies whether they are treated pharmacologically or not – Percent of infants requiring a dose escalation or failing a weaning step • This will use data from the first phase of NAS in addition to the new Orchestrated Testing data collection form to give us a run chart starting in January 2014 – Percent of infants with >10% weight loss • Severity of withdrawal 20
Orchestrated Testing Measures • New balancing measures: – Highest Finnegan score in 24 hours prior to starting treatment – Number of Finnegan scores >12 in 24 hours prior to starting treatment 21
New/Phase 2 Data Collection Paper form: OPQC does NOT collect this form. All data must be entered electronically . Sites are encouraged to use the paper to collect their data prior to entry. This form can be found on the OPQC SharePoint member sign in page. www.opqc.net 22
Eligibility Any infant ≥37 weeks gestational age at birth with IN UTERO opioid exposure and with the diagnosis of Narcotic Abstinence Syndrome (NAS) who is identified after birth and is being monitored for signs and symptoms of opiate withdrawal with the Finnegan scoring system. Infants may be inborn or outborn and transferred to a participating center after birth. Infants may be born outside the state of Ohio. Exclusion Infants who were only exposed to opioids postnatally are not included in this study. 23
What if I don’t have any eligible babies for a calendar month? (calendar month based on the baby birth month) 1. Fill in the Checkbox and indicate the Month/Year you did not have any babies 2. Once the data entry system is ready – you will check this box and hit Submit 3. Do not fill out the rest of the form 24
If no, please answer Question #2A and #2B The following data will be collected on OUTBORN (transferred in) babies. • DOL was baby transferred to your hospital • Type(s) of NAS treatment or support at the transferring hospital • The DOL treatment started at the transferring hospital • A few details on the NAS treatment at the transferring hospital • How was the baby fed at the transferring hospital ***I f the baby was Inborn – please skip this section and proceed to Question #3 25
Baby’s Weight Question #4: Baby birth weight please record in grams Question #5: Record the baby’s lowest weight in the first 7 days of life please record in grams 26
Maternal Drug Exposure Question #6 - 11: Questions in this section ask about mom’s exposure to drugs or tobacco during this pregnancy and include greater detail than questions found on the Phase 1 Data Collection Form Additional questions include: • Is mom actively in a drug treatment program • Drug exposure to prescribed opiates • other than treatment program opiates • you can find a list of opiates in the data instruction document • Drug exposure to heroin • Drug exposure to illicit opiates • other than heroin • Drug exposure to other drugs not listed above • you can find a list of other drugs in the data instruction document • Did mom smoke tobacco cigarettes during this pregnancy 27
Additional detail regarding Non-Pharmacologic Treatment (at your hospital) Question #13: Indicate how this baby was fed at your hospital (check all that apply) – Formula, Breast Milk or Other type of feed – For each type of feed • Complete calorie content and indicate DOL start and DOL stop • If the feed was low lactose, indicate DOL start and DOL stop 28
Recommend
More recommend
