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Welcome to the OPQC NAS October Action Period Call

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Neonatal Abstinence Syndrome Project October Action Period Call

Ohio Perinatal Quality Collaborative October 2015

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Time Topic Presenter 12:00 pm Welcome & Agenda Review Learning Session Highlights Andrea Hoberman, MPH 12:10 pm Data Overview Heather Kaplan, MD 12:25 pm Phase 2:

New Data Measures & Collection Forms Learning Lab Structure for Groups 1-4

Andrea Hoberman 12:35 pm New Data SharePoint Functionality Dan Jeffers, MS 12:45 pm Team Discussion – Q&A All teams 12:55 pm Next Steps

• Data Submission Reminder
• MPR/PDSA Reminder
• Learning Lab Calls

Andrea Hoberman

Agenda

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Learning Session Highlights

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3 3 4 5 10 10 12 17 5 10 15 20 MCO Finnegan Scoring Data Collection Flow Charts Reliability Other PDSAs Formula Info

What one strategy that you heard today will you want to test or implement at your site? (n=66)

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Key Driver Diagram

Project Name: OPQC Neonatal NAS Leader: Walsh SMART AIM KEY DRIVERS INTERVENTIONS

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 1 day across participating sites by June 30, 2016. Improve recognition and non- judgmental support for Narcotic addicted women and infants Connect with outpatient support and treatment program prior to discharge Standardize NAS Treatment Protocol Optimize Non-Pharmacologic Rx Bundle

• Initiate Rx If NAS score > 8 twice.
• Stabilization/ Escalation Phase
• Wean when stable for 48 hrs by 10%

daily.

• Swaddling, low stimulation.
• Encourage kangaroo care
• Feed on demand- MBM if appropriate
• r lactose free, 22 cal formula
• All MD and RN staff to view “Nurture

the Mother- Nurture the Child”

• Monthly education on addiction care

Attain high reliability in NAS scoring by nursing staff Partner with Families to Establish Safety Plan for Infant

• Fulltime RN staff at Level 2 and 3 to

complete D’Apolito NAS scoring training video and achieve 90% reliability.

• Establish agreement with outpatient

program and/or Mental Health

• Utilize Early Intervention Services
• Collaborate with DHS/ CPS to ensure

infant safety.

Prenatal Identification of Mom Implement Optimal Med Rx Program

• Engage families in Safety Planning.

Partner with other stakeholders to influence policy and primary prevention.

• Provide primary prevention materials to

sites. To reduce the number of moms and babies with narcotic exposure, and reduce the need for treatment of NAS.

GLOBAL AIM

Collaborative Aggregate Data Submission

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% Infants that Received ANY Non Pharmacologic Elements Before Drug Treatment

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% Non Pharmacologic Bundle Compliance

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Distribution of Non-Pharmacologic Care Elements Received Before Drug Treatment (Purple)

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% Infants that Received Pharmacologic Treatment

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% Pharamacologic Bundle Compliance

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Distribution of Pharmacologic Treatment Elements Received (Pink)

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Average Length of Opiate Treatment

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Average Length of Stay for Pharmacologically Treated Babies

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OPQC NAS Phase 2 Timeline

July Aug Sept October-June July

Hospitals commit to participate Sites self select to 1 of 4 formula groups Test & finalize Data Collection Form Test & finalize Data Collection Instructions Call with Lead Physicians (August) Learning Session— PROJECT KICK OFF Run OT Testing “Learning Lab” AP Calls Quarterly Action Period Group Calls Data Collection & Submission Continued work on other Key Drivers Analyze Results Update & Implement Best Care Practices

Phase 2 data collection begins with babies born after 10/1/15

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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

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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

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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

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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

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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

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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.

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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

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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

***If the baby was Inborn – please skip this section and proceed to Question #3

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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

Baby’s Weight

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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
• ther 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
• ther 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

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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

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Pharmacologic Treatment (at your hospital)

Question #14: Did the baby receive pharmacologic treatment at your hospital?

– Yes, No or Can’t Determine

• If yes: additional questions include:

– Finnegan score >12 and the highest score in the 24 hours prior to starting pharmacologic treatment on this baby – When was treatment initiated and was the primary drug used? – Did you follow your hospital NAS protocol for this baby?

• Please review your hospital protocol to respond to questions in this section

– Was a dose escalation necessary? If yes when? – Did the baby fail a wean step? – Did the baby follow your hospitals NAS treatment weaning schedule? – Was a secondary medication used? If yes, what medication and when did you initiate it? – Was this baby discharged on drug to treat NAS? If yes, which drug and how long was the baby treated?

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OPQC Orchestrated Testing Groupings

Group 22 kcal/oz Standard Low Lactose Standard 1 Yes Yes 2 Yes No 3 No Yes 4 No No

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Learning Lab Calls

Group 1 – 2nd Wed at 2pm Group 2- 2nd Wed at 1pm Group 3 – 3rd Wed at 2pm Group 4- 3rd Tues at 3pm October – Quarterly Action Period Call Nov 11 at 2pm Nov 11 at 1pm Nov 18 at 2pm Nov 17 at 3pm Dec 9 at 2pm Dec 9 at 1pm Dec 16 at 2pm Dec 15 at 3pm January – Quarterly Action Period Call Feb 10 at 2pm Feb 10 at 1pm Feb 17 at 2pm Feb 16 at 3pm March – OPQC Spring Learning Session April – Quarterly Action Period Call May 11 at 2pm May 11 at 1pm May 18 at 2pm May 17 at 3pm June 8 at 2pm June 8 at 1pm June 15 at 2pm June 21 at 3pm July – Quarterly Action Period Call

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Poll Question

Have you had the opportunity to use the new Phase 2 Data Collection Form?

– Yes – No, we’ve not yet collected data for babies born since 10/1 – No, we’ve not had any NAS babies since 10/1

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Technology Updates

Online reporting Dan Jeffers

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What’s new?

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What’s still coming?

• Online reporting instead of pdf
• Daily data refresh
• Chart display flexibility
• Simplified workflow
• One stop shopping

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Report Settings

• Display options
• Measure
• Start/end dates
• Y-axis min/max
• Hospital, group, region
• Show/hide centerline, goal line

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LIVE DEMO

OPQC NAS Reports

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An example…

• Interested in aggregate LOT since June

2014

Let’s drill down

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Drilling in…

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What stays the same?

• OPQC portal/web site
• User name/password
• Data security
• Report layout

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But wait, there’s more

• Planned enhancements
• Ability to create pdf on demand
• Annotation capability
• Your suggestions
• Send suggestions/wishes to

daniel.jeffers@cchmc.org

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What if I need help?

• Tip sheet distributed at the OPQC

9/28 Learning Session

• help-opqc@bmi.cchmc.org

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Questions??

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Next Steps

• Invites for group specific Learning Lab Calls

were emailed on October 21st. Please attend!!

• Please use the Phase 2 Data Collection Form for all

NAS babies born on/after October 1st.

• Please submit NAS September Data (as well as data

prior to September) ASAP. Remember to please submit and check “No Eligible Babies for the Month” if there were no NAS patients at your site.

• Monthly Progress Report was be sent to Key

Contacts last week; due October 30th.

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The OPQC NAS Project is funded by The Ohio Department of Medicaid

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