Implementing Practice Guidelines and Education to Improve Care of Infants With Neonatal Abstinence Syndrome

Lucas, Katherine; Knobel, Robin B.

doi:10.1097/anc.0b013e318241bd73

Cited by 40 publications

(30 citation statements)

References 17 publications

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“…In web‐based learning environments, the duration varied from one short web‐based tutorial session or a four‐day workshop to five weeks (see Table ). The durations were not described in three studies (Lucas & Knobel , Hanrahan , Hargraves ). The participants of most of the interventions were nurses, but in one intervention (Hanrahan ) they also included physicians, nurse practitioners and medical residents.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation

Häggman‐Laitila

Mattila²,

Melender

2016

Journal of Clinical Nursing

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Section: Resultsmentioning

confidence: 99%

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation

Häggman‐Laitila

Mattila²,

Melender

2016

Journal of Clinical Nursing

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“…Administrators of the Finnegan were educated using the D’Apolito Reliability Training (including an interactive DVD and proctored scoring) 16,23 . In general, hospital protocols dictated that Finnegan scores be assigned every 3–4 hours starting within 24 hours of age for all infants exposed to opioids.…”

Section: Methodsmentioning

confidence: 99%

Pharmacokinetics of Oral Methadone in the Treatment of Neonatal Abstinence Syndrome: A Pilot Study

Wiles

Isemann

Mizuno

et al. 2015

The Journal of Pediatrics

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Objective To characterize the population pharmacokinetic (PK) of oral methadone in neonates requiring pharmacologic treatment of neonatal abstinence syndrome (NAS) and to develop a PK model towards an evidence-based treatment protocol. Study design Based on a methadone dosing protocol, serum concentrations of methadone and its metabolites were assessed via high performance liquid chromatography-tandem mass spectrometry from dried blood spots. Population PK analysis was performed to determine the volume of distribution and clearance of oral methadone. Methadone plasma concentration-time profiles were simulated from the deduced PK model to optimize the dosing regimen. Results There was substantial inter-individual variability in methadone concentrations. Blood concentrations of methadone were best described by a one-compartment model with first-order absorption. The population mean estimates (coefficient of variation percentage) for oral clearance and volume of distribution were 8.94 (103%) L/h/70 kg and 177 (133%) L/70 kg, respectively. Optimized dosing strategies were developed based on the simulated PK profiles. We suggest a starting dose of 0.1 mg/kg per dose every 6 hours for most patients requiring pharmacologic treatment of NAS followed by an expedited weaning phase. Conclusions The proposed dosing regimen may reduce the cumulative dose of opioid and shorten the length of hospitalization. Future studies should aim to validate the simulated dosing schemes with clinical data and expand our understanding of the between-patient PK variability. Trial registration ClinicalTrials.gov: NCT01754324

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“…The details of the protocol development, including nonpharmacologic and pharmacologic components, and prestudy training in standardization of Finnegan scoring and NAS treatment have been described previously. 17,18 Infants born at $34 weeks' gestation who were treated pharmacologically for NAS with methadone or morphine were included in the analysis. Infants who received iatrogenic opioid treatment or who had significant medical conditions necessitating surgical intervention or mechanical ventilation were not included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

et al. 2015

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, on behalf of the OCHNAS Consortium abstract OBJECTIVES: To evaluate the generalizability of stringent protocol-driven weaning in improving total duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS). METHODS:We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio's 6 children's hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning.RESULTS: After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P , .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P , .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption (duration of treatment = 17.0 days and length of hospital stay = 23.3 days).CONCLUSIONS: Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.WHAT'S KNOWN ON THIS SUBJECT: Use of a standard treatment protocol with stringent weaning guidelines for infants with neonatal abstinence syndrome supports improved outcomes including shorter duration of opioid exposure and length of hospital stay. WHAT THIS STUDY ADDS:We demonstrate generalizability of a protocol-driven weaning strategy for improvement in hospital outcomes for neonatal abstinence syndrome. After adoption, adherent protocol-adopting centers improved outcomes and eliminated differences in outcomes compared with centers with preexisting stringent weaning protocols.

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Implementing Practice Guidelines and Education to Improve Care of Infants With Neonatal Abstinence Syndrome

Abstract: : Evidence-based clinical practice guidelines and education around NAS and the FNAST equip caregivers with the necessary tools to consistently and accurately assess an infant with NAS when using the FNAST.

Cited by 40 publications

References 17 publications

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation

Pharmacokinetics of Oral Methadone in the Treatment of Neonatal Abstinence Syndrome: A Pilot Study

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

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