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Neonatal Abstinence Syndrome: Evaluating the Effectiveness of an Evidence-Based Multidisciplinary Care Approach

Saunders, Carla BSN, NNP-BC; King, Terry Pharm D, BCPS; Smith, Sheri BSN, RN; Buchheit, John MD; Cook, Kyle MSN, NNP-BC; Edds, Jill MSSW, LCSW; Mefford, Linda PhD, RN, NNP-BCthe Neonatal Abstinence Syndrome Task Force of East Tennessee Children's Hospital

The Journal of Perinatal & Neonatal Nursing: July/September 2014 - Volume 28 - Issue 3 - p 232–240
doi: 10.1097/JPN.0000000000000049
Feature Articles

An evidence-based, multidisciplinary neonatal abstinence syndrome protocol was developed using a stepwise continuous quality improvement (CQI) approach with the goal of standardizing care procedures for these infants. A retrospective secondary data analysis was performed to evaluate the differential effects of each step of the CQI project on 4 key clinical outcome measures: length of stay (total and post–opioid wean), weaning time from opioids, and use of adjunct medications. Data were analyzed from 386 newborn infants with a diagnosis of neonatal abstinence syndrome undergoing treatment in a level III neonatal intensive care unit. After implementation of a pharmacologic weaning protocol as a foundational first step of the CQI project, the weaning time from opioids remained stable throughout each of the subsequent CQI steps (P = .905). The overall total neonatal intensive care unit length of stay was reduced by 10.35 days (P = .002), and the length of neonatal intensive care unit stay after completing wean from opioids was reduced by 2.79 days (P < .001). Use of adjunct medications also decreased from 30.1% of infants at the initiation of the CQI project to 24.5% at the completion of the project (P = .020). These findings indicate that this multidisciplinary treatment approach led to an overall improved efficiency of both opioid weaning and symptom management for these infants.

Pediatrix Medical Group (Mss Saunders and Cook and Dr Buchheit), East Tennessee Children's Hospital, Knoxville (Mss Saunders, Smith, Cook, and Edds and Drs King and Buchheit); and The University of Tennessee, Knoxville, College of Nursing (Dr Mefford).

Corresponding Author: Carla Saunders, BSN, NNP-BC, East Tennessee Children's Hospital, 2018 Clinch Ave, Ste 320, Knoxville, TN 37916 (

Members of the author team are affiliated with the institutions at which this project was implemented, as listed above. Dr Mefford's work on this project was supported by a collaborative research contract between East Tennessee Children's Hospital and The University of Tennessee, Knoxville, College of Nursing.

The authors gratefully acknowledge the staff at East Tennessee Children's Hospital for their dedication and compassion in the care of these babies and families. The authors also acknowledge Cary Springer of the Office of Information Technology of the University of Tennessee, Knoxville, for assistance with data analysis, and Dr Alan Spitzer of Pediatrix for editorial review.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: January 15, 2014; accepted for publication: May 24, 2014.

© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.