Welcome to the OPQC NAS February Action Period Call

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Neonatal Abstinence Syndrome Project

Action Period Call

Ohio Perinatal Quality Collaborative February 2015

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Time Topic Presenter

3:00 pm Welcome, Agenda Review, sign in

Susan Ford, RN

3:05 pm Data Overview – January Results Scott Wexelblatt, MD

3:15 pm Learning Session Overview Susan Ford, RN

3:20 pm Sharing Seamlessly – What are other Teams Testing? Team Discussion

• Site 1 • Site 2 • Site 3 All teams

3:50 pm Next Steps •Data Submission Reminder •Attitude Measures Survey •MPR/PDSA Reminder

Susan Ford, RN

Agenda

Roll Call: Please sign in with your hospital affiliation and the

names of your team members on the call in the Question box

Promedica Toledo Children’s

Miami Valley

Mercy Anderson

Aultman

Mt. Carmel East OSU

UH Rainbow Babies & Children’s

Bethesda North Hospital

Nationwide Dublin Methodist

Akron Children’s Summa

Cincinnati Children’s

Hillcrest Hospital Fairview Hospital

Cleveland Clinic

Dayton Children’s

Nationwide Riverside Methodist

Nationwide Grant

Nationwide Mt. Carmel St. Ann’s

UH Cincinnati

Good Samaritan Hospital

MetroHealth

Mt. Carmel West Nationwide Doctor’s

Akron Children’s

Nationwide Children’s

Mercy Children’s Hospital

Atrium Medical Center

Fort Hamilton

Mercy Hospital Fairfield

Mercy Medical Center Canton

The Christ Hospital

St. Rita’s Medical Center

Southview Medical Center

Good Samaritan Hospital Dayton

Kettering

Mercy Health West

Southern Ohio Medical Center

Genesis Healthcare System

OhioHealth MedCentral Mansfield

Marion General

Elyria Medical Center -UH

Mercy Regional Medical Center Lorain ProMedica

Bay Park

Lima Memorial Health System

Springfield Regional Medical Center

Adena Regional

Medical Center

Soin Medical Center

Upper Valley Medical Center

Licking Memorial Health System

NAS Participating Sites 2014

1/2014 start Level 3 and Level 2 teams

Akron Children’s

St. Elizabeth Health

Center/Mahoning Valley

Trumbull Memorial

4/2014 start Level 2 teams

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 20% across participating sites by June 30, 2015.

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 or 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

OPQC/NAS Learning Session

PDSA Report Out Results from January 26, 2015

PDSA’s: What change can we make that will result in an improvement?

Why Test?

• To reduce the risk/cost of implementing an intervention testing provides an opportunity to learn without severely impacting performance

• To increase (or decrease) your belief that

the change will result in improvement

• To learn how to adapt the change to other conditions in your environment

• To minimize resistance to implementation

What is Not a Test?

• Data collection • Implementing a solution • Rolling out an educational

program • Getting a form, policy,

procedure approved by the official committees

Keep it small!!

• 1 PDSA

• 1 Baby • 1 Day

Site 1 Partnering with a local Drug Court

• Provides: care coordinators, a legal aid attorney, a nurse case manager, a maternal fetal medicine physician, an addiction medicine physician , trauma-informed, and psychologist

• A referral could be implemented via sentencing or as part of probation criteria to help to ensure women get the necessary prenatal care.

PDSA- Site 2

• Plan: We plan to increase core team knowledge of community resources so we are better able to understand and articulate to front line staff those resources that are available to the mothers. We will accomplish this by 1-23-2015.

• KEY DRIVER- Connect with outpatient support and treatment programs prior to discharge.

• Do: Members of our OPQC team visited 1 of the treatment programs in the area to better understand our moms’ experiences with the program and to educate staff on the information learned. We went to a local methadone clinic on 1-23-2015.

PDSA- Site 2

• Study: After our first visit to one of our community partners, we found that those team members that attended had a much better understanding of the services that are available. Not all members of our OPQC core team were able to attend, so we presented the information to those who did not attend.

• Act: The group determined that our visit went very well. Not only did we learn more about its services, but we were actually able to educate the staff about Neonatal Abstinence Syndrome. Since we were able to easily convey the knowledge to those who did not attend, we scheduled an appointment with a second community agency. Appointment dates set for 2-20 & 2-26. We have already discussed a potential 3rd agency to meet with in March.

Site 3 PDSA: Community Resources

Key Driver impacted: Connect with outpatient support and treatment program prior to discharge.

PLAN: Maternity staff to build positive relationships with community resource clients to enhance their birthing experience.

Site 3 PDSA: Community Resources

PLAN: TASKS TO DESCRIBE THE TEST 1. Every other month scheduled tour by Perinatal Educator of Maternity unit with community agency clients. Question and answer session provided. 2. Purple crying and safe sleep presentation provided by Pediatrician after tour 3. Child birth class given by Maternity staff at community agency for clients with Finnegan assessments included in detail

Site 3 PDSA: Community Resources

PLAN: TASKS TO EVALUATE THE TEST 1. Patient rounding of community agency clients after birthing experience to obtain feedback of the Maternity staff and physician interactions prior to delivery 2. Maternity feedback on observation of relationships with community agency clients while in unit

PLAN: PREDICTION Increased trust will be seen in care provided by Maternity staff by community agency clients

Site 3 PDSA: Community Resources

DO: 1. The plan was carried out as described. 2. Observations and verbal feedback from community agency clients and Maternity staff supported the design of the plan. 3. Observation not part of the plan involved the increased compassion and interest the nursing staff began to show toward community agency clients beyond the basic nursing job requirements.

Site 3 PDSA: Community Resources

STUDY: The results of the plan matched the predictions.

ACT: Adopt the plan with goals set to implement and sustain the plan because of the “win – win” benefits for both Maternity staff and community agency clients.

What has YOUR team been working on since the Learning

Session??

Attitude Measure Survey Key Driver: Improve recognition and non-judgmental

support for Narcotic addicted women and infants

To be completed by ALL of the following staff in your Unit: • Attending MD’s • Fellows • NNP’s • RN’s • Social Workers

7 short questions

Upcoming ASTHO webinar

OPQC Newsletter

• Do you have an exciting program, PDSA, or piece of advice to share with other NAS teams? Please consider submitting a brief write-up to the OPQC Newsletter! – OPQC staff will be happy to informally “interview” you

to learn more about your team and help draft an article for our newsletter.

– The OPQC NAS newsletter is distributed

electronically to nearly 400 recipients on a bi-weekly basis.

OPQC Newsletter

• Suggestions for newsletter articles include: – PDSA of the month (share challenges and

successes) – CEO/CNO/CQO corner (highlight your

leadership engagement) – Meet the team spotlight (introduce us to

your team members and community) • Please tell us: What would you like to read

about in the NAS OPQC newsletter?

Next Steps • Continue testing small tests of change (PDSA)

• Look for and complete the Attitude Measures Survey

by March 9th. • Please submit NAS Data by March 2nd. Remember

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

• Monthly Progress Report will be sent to Key

Contacts this Friday; due March 2nd

The OPQC NAS Project is funded by The Ohio

Department of Medicaid