Asti Lindsey, Magers Jacqueline S, Keels Erin, Wispe Jonathan, McClead Richard E
The Research Institute, and Colleges of Public Health and.
Nationwide Children's Hospital, Columbus, Ohio;
Pediatrics. 2015 Jun;135(6):e1494-500. doi: 10.1542/peds.2014-1269. Epub 2015 May 4.
Neonatal abstinence syndrome (NAS), a self-limiting condition, is associated with clinical symptoms that may require pharmacological intervention. Optimal treatment of NAS remains undetermined, but the hospital length of stay (LOS) for patients with NAS is partially dependent upon a standard treatment protocol used. Prolonged LOS for patients with NAS can lead to adverse patient harm, impaired maternal-infant attachment, and significant health care costs. Therefore, we conducted a quality improvement study to reduce the LOS for infants with NAS.
In 2009, a multidisciplinary NAS Taskforce was created to implement a standardized treatment protocol, discuss the strengths and weaknesses of the current medical and nursing management, and improve communication among staff. Infants with NAS that required pharmacological intervention were followed throughout their hospitalization. Readmission within 30 days of hospital discharge was tracked as a balancing measure.
Ninety-two infants were eligible for the project including 23 infants from a baseline period (January 2007-August 2009). Reliable monitoring of symptoms and the administration of a standardized morphine protocol effectively reduced LOS from 36 days to 18 days by June 2012. This improvement was sustained through December 2012. No patients were readmitted for NAS treatment.
The most effective interventions that impacted LOS for infants with NAS were the development of a staff NAS education program and the implementation of a standard treatment protocol. The formation of the NAS Taskforce was also essential because it facilitated communication and the dissemination of vital treatment information among all clinical staff.
新生儿戒断综合征（NAS）是一种自限性疾病，伴有可能需要药物干预的临床症状。NAS的最佳治疗方案尚未确定，但NAS患者的住院时间（LOS）部分取决于所采用的标准治疗方案。NAS患者住院时间延长可导致不良的患者伤害、母婴依恋受损以及高额的医疗费用。因此，我们开展了一项质量改进研究以缩短NAS婴儿的住院时间。
2009年，成立了一个多学科NAS特别工作组，以实施标准化治疗方案，讨论当前医疗和护理管理的优缺点，并改善工作人员之间的沟通。对需要药物干预的NAS婴儿在其住院期间进行跟踪。将出院后30天内的再次入院情况作为一项平衡指标进行跟踪。
92名婴儿符合该项目条件，其中包括23名基线期（2007年1月至2009年8月）的婴儿。通过对症状进行可靠监测并实施标准化吗啡方案，到2012年6月，住院时间有效地从36天缩短至18天。这一改善一直持续到2012年12月。没有患者因NAS治疗而再次入院。
对NAS婴儿住院时间产生影响的最有效干预措施是制定工作人员NAS教育计划和实施标准治疗方案。NAS特别工作组的组建也至关重要，因为它促进了所有临床工作人员之间的沟通和重要治疗信息的传播。
