Neonatal Abstinence Syndrome
Newborns with NAS 5X Longer Hospital Stays
(average of 17.1 days)

PA Health Care Cost Containment Council

The PA PQC was launched in April 2019 as an action arm of the Pennsylvania Maternal Mortality Review Committee (MMRC) to improve the identification of and care for pregnant and postpartum women with Opioid Use Disorder (OUD) and Opioid-exposed newborns. As of January 2021, the quality improvement projects of PA PQC providers teams have led to improvements, such as: an increase of 19% in the average percentage of nurses caring for newborns who were trained on validated Neonatal Abstinence Syndrome (NAS) assessments in the past year; a 12% increase in the number of sites with quality improvement efforts in place to increase inter-rater reliability for NAS assessments; and a 22% increase in sites using standardized non-pharmacologic protocols to care for newborns with NAS.

Goals
  • Increase reliable assessments of opioid-exposed newborns
  • Increase use of standardized non-pharmacological treatment bundles for opioid-exposed newborns
  • Increase use of standardized pharmacological treatment bundles for opioid-exposed newborns
  • Decrease length of stay for newborns with NAS
  • Create a safe environment by connecting the mom and baby dyad to wrap around supports prior to discharge
  • Increase engagement in home visitation services for mothers and infants exposed to opioids
  • Care for the mom and baby dyad for 15 months through well-child visits
Key Interventions
Get Involved

New PA PQC provider organizations and teams typically start with a quality improvement project on maternal OUD or NAS. As a result, the PA PQC has an ongoing open enrollment period for PA PQC provider teams to start a maternal OUD or NAS quality improvement project. The PA PQC encourages all PA PQC provider teams to continuously improve care for maternal OUD and NAS.

  1. Ensure your birth site is a member of the PA PQC (join here if your team is not yet involved in the PA PQC)
  2. Identify a multi-disciplinary NAS quality improvement team with inpatient and community representatives (please review the PA PQC Brief for the roles of core PA PQC team members)
  3. Contact your birth site’s or NICU’s PA PQC quality improvement coach or papqc@whamglobal.org for guidance on how to begin your birth site’s or NICU’s PA PQC NAS quality improvement project
Expectations

With guidance from your PA PQC quality improvement coach:

  • Further expand, develop, and structure your multi-disciplinary team
  • Organize monthly quality improvement team meetings to prioritize and adopt the PA PQC maternal NAS key interventions based on your current condition
  • Develop and implement a quality improvement plan and protocols with your team, making continuous improvements
  • Complete quarterly NAS surveys to track your team’s impact on the NAS structure measures compared to your peers in the PA PQC
  • Submit aggregated numerators and denominators for the monthly PA PQC NAS process and outcome measures—hospital LOS for NAS, non-pharmacologic treatment rate, pharmacologic treatment rate, and referral to appropriate follow-up services rate) via the PA PQC data portal to track your improvement over time
  • Provide a Quality Improvement Report Out, using the QI Report Out Template, prior to each quarterly PA PQC Learning Session
  • Attend the quarterly PA PQC Learning Sessions
  • Attend the PA PQC Quality Improvement Collaborative Meetings for peer-to-peer learning around NAS in-between the Learning Sessions
Resources

NAS Resources
(NAS case definitions, NAS assessment trainings, presentations, Plans of Safe Care guidance, Early Intervention Resources, Vermont Oxford Network NAS Training)

Community Resources
(OUD PacMATs and COEs, SUD Single County Authorities, Family Resources)