Abstract
Purpose: The purpose of this project was to implement a new scoring tool to alleviate interrater bias, decrease length of stay (LOS), and decrease pharmacologic use for treatment.|Background: Neonatal Abstinence Syndrome (NAS) is diagnosed when an infant displays signs of withdrawal after being exposed to addicting substances in utero. One infant is diagnosed with NAS every 19 minutes. An NAS diagnosis in the United States has quadrupled in the last decade. Currently, the Finnegan Neonatal Abstinence Scoring System (FNASS) is the most used scoring method. There are guidelines to treat based on severity of scores but accuracy of scoring. Inaccuracy of scoring can lead to higher patient care costs.|Sample/Setting: This QI project was implemented in a 30- bed level III NICU and the Normal Newborn Unit at Bryan Medical Center in Lincoln, Nebraska. A total of six term infants were enrolled in the program.|Methods: Several scoring tools were researched to determine the most effective tool for consistently scoring NAS symptoms. The Eat, Sleep, Console (ESC) approach scored based off infant’s function during withdrawal rather than symptoms. ESC research showed a decrease in LOS and need for pharmacologic treatment. Rogers’ diffusion theory provided the framework for implementation. The staff involved were informed, educated, and implemented the ESC program. A PDSA model was then utilized to improve process after implementation.|Results: Six infants were treated using ESC program (n=6). There was no interrater variability. Average LOS was 4.5 days. All six infants did not require pharmacologic use when scored in the ESC program but two would have required medication when scored, for comparison, with the previous FNASS protocol- a 33% decrease.|Conclusion: FNASS is currently the most used tool for scoring NAS. ESC was shown be a more effective tool to score and treat neonates based on less interrater variability, a decrease in average length of stay, and decrease use in pharmacologic interventions for this facility.