Implementing Practice Protocols and Education to Improve the Care of Infants with Neonatal Abstinence Syndrome


Paper Presentation

Purpose of the Program

The National Council on Alcoholism and Drug Dependency estimates that between 1% and 11% of babies born each year are exposed to illicit substances in utero. The American Academy of Pediatrics reported that 50% to 95% of infants exposed to opioids or opioid derivatives, including heroin and methadone, develop neonatal abstinence syndrome (NAS). Research that is more recent describes an increasing incidence of infants exposed to harmful substances prior to birth. Babies exposed to opioids or opioid derivatives during pregnancy are at increased risk of developing NAS. Optimal treatment of this NAS population is hampered by the current lack of evidence-based standardized guidelines and protocols for pharmacologic management and care that promote improved outcomes for NAS patients. Care and management of these infants can be improved with practice guidelines and education.

Proposed Change

To develop and implement evidence-based clinical practice guidelines and an educational program on NAS and the Finnegan Neonatal Abstinence Scoring Tool (FNAST), to improve nursing assessment and care of the NAS infant, and improve scoring accuracy with use of the FNAST.

Implementation, Outcomes, and Evaluation

This study was a nonexperimental, pretest/ posttest study that evaluated change in nursing knowledge about NAS and use of the FNAST after the implementation of a quality improvement, educational project. Nurses were tested before and after participation in education about NAS. A subset of 10 nurses was evaluated using the FNAST with video of infants having NAS. Volunteer participation in the NAS educational project occurred in 81% of the neonatal intensive care unit nurses. All nurses showed some improvement in scores on the posttest, with 2% to 44% improvement. All 10 nurses who participated in the interactive video test scored 90% or higher against the FNAST criterion 1 week after participation in the educational project.

Implications for Nursing Practice

Evidenced-based clinical practice guidelines and education on NAS and the FNAST equip caregivers with the necessary tools to consistently and accurately assess an infant with NAS when using the FNAST. Recent research shows that providing education to nurses can result in knowledge gained, improved professional practice, and improved patient treatment goals. Education also can equip nurses with the necessary knowledge to care for patients with complex medical problems like NAS. Further, providing nurses with specific information about a medical problem is correlated with improved adherence to best practice.