一项旨在提高芬尼根工具评分一致性和准确性的质量改进计划：新生儿戒断综合征中获得可靠药物戒断评估的挑战。
A Quality Improvement Initiative to Increase Scoring Consistency and Accuracy of the Finnegan Tool: Challenges in Obtaining Reliable Assessments of Drug Withdrawal in Neonatal Abstinence Syndrome.
作者信息
Timpson Wendy, Killoran Cheryl, Maranda Louise, Picarillo Alan, Bloch-Salisbury Elisabeth
机构信息
Division of Neonatology and Division of Newborn Nursery, University of Massachusetts Memorial Healthcare Center, Worcester (Drs Timpson and Picarillo and Ms Killoran); and Department of Quantitative Health Sciences (Dr Maranda) and Department of Pediatrics, University of Massachusetts Medical School, Worcester (Dr Bloch-Salisbury). Dr Timpson is now with Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Dr Picarillo is now with Division of Neonatology, Barbara Bush Children's Hospital, Maine Medical Center, Portland, ME.
出版信息
Adv Neonatal Care. 2018 Feb;18(1):70-78. doi: 10.1097/ANC.0000000000000441.
BACKGROUND
Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs.
PURPOSE
This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses.
METHODS
One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale. Nurses scored a standardized video-recorded infant presenting with opioid withdrawal before and after training.
RESULTS
Nearly twice as many nurses scored at target (Finnegan score of 8) posttraining (34.7%; mean error = 0.559, SD = 1.4) compared with pretraining (18.8%; mean error = 1.31, SD = 1.95; Wilcoxon, P < .001). Finnegan scores were significantly higher than the target score pretraining (mean = 9.31, SD = 1.95) compared with posttraining (mean = 8.56, SD = 1.40, Wilcoxon P < .001); follow-up assessments reverted to pretraining levels (mean = 9.16, SD = 1.8). Score dispersion was greater pretraining (variance 3.80) compared with posttraining (variance 1.96; Kendall's Coefficient, P < .001) largely due to score disparity among central nervous system symptomology.
IMPLICATIONS FOR PRACTICE
Education, clinical guidelines, and a restructured scoring tool increased consistency and accuracy of infant withdrawal-assessments among neonatal nurses. However, more than 60% of nurses did not assess withdrawal to the target score immediately following the training period and improvements did not persist over time.
IMPLICATIONS FOR RESEARCH
This study highlights the need for more objective tools to quantify withdrawal severity given that assessments are the primary driver of pharmacological management in neonatal drug withdrawal.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
背景
目前诊断新生儿戒断综合征及指导新生儿药物戒断的药物治疗的方法依赖于护理评估和对临床体征的反复评估。
目的
这项单中心质量改进计划旨在提高新生儿护士芬尼根评分的准确性和一致性。
方法
170名新生儿护士参加了一个包含教育、评分指南和重新构建的芬尼根量表的单次戒断评估项目。护士们在培训前后对一段标准化视频中表现出阿片类药物戒断症状的婴儿进行评分。
结果
与培训前（18.8%；平均误差=1.31，标准差=1.95）相比，培训后达到目标评分（芬尼根评分为8）的护士人数几乎增加了一倍（34.7%；平均误差=0.559，标准差=1.4）（威尔科克森检验，P<.００１）。与培训后（平均=8.56，标准差=1.40，威尔科克森检验P<.００１）相比，培训前芬尼根评分显著高于目标评分（平均=9.31，标准差=1.95）；随访评估恢复到培训前水平（平均=9.16，标准差=1.8）。培训前评分离散度更大（方差3.８０），而培训后（方差1.96；肯德尔系数，P<.００１），这主要是由于中枢神经系统症状学评分存在差异。
对实践的启示
教育、临床指南和重新构建的评分工具提高了新生儿护士对婴儿戒断评估的一致性和准确性。然而，超过60%的护士在培训期结束后没有立即将戒断评估到目标评分，且随着时间推移改进效果没有持续。
对研究的启示
鉴于评估是新生儿药物戒断药物治疗的主要驱动因素，本研究强调需要更客观的工具来量化戒断严重程度。视频摘要见https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx。
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