Welcome to the OPQC NAS November Action Period Call
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Neonatal Abstinence Syndrome Project
Action Period Call
Ohio Perinatal Quality Collaborative November 21, 2014
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Time Topic Presenter
12:00 pm Welcome, Agenda Review, sign in Susan Ford
12:05 pm Data Overview – October Results Scott Wexelblatt, MD
12:15 pm Community Resources • Site 1 • Site 2 • Site 3 • Discussion/Team Sharing
Presenter 1 Presenter 2 Presenter 3 All Teams
12:50 pm Next Steps •PDSA Submissions •Save the Date –
•OCPIM Summit •OPQC Learning Session
•Data Submission Reminder •Monthly Progress Report Reminder
Susan Ford
Agenda
Roll Call: Please sign in with your hospital affiliation and the
names of your team members on the call in the Question box
Promedica Toledo Children’s
Miami Valley
Mercy Anderson
Aultman
Mt. Carmel East OSU
UH Rainbow Babies & Children’s
Bethesda North Hospital
Nationwide Dublin Methodist
Akron Children’s Summa
Cincinnati Children’s
Hillcrest Hospital Fairview Hospital
Cleveland Clinic
Dayton Children’s
Nationwide Riverside Methodist
Nationwide Grant
Nationwide Mt. Carmel St. Ann’s
UH Cincinnati
Good Samaritan Hospital
MetroHealth
Mt. Carmel West Nationwide Doctor’s
Akron Children’s
Nationwide Children’s
Mercy Children’s Hospital
Atrium Medical Center
Fort Hamilton
Mercy Hospital Fairfield
Mercy Medical Center Canton
The Christ Hospital
St. Rita’s Medical Center
Southview Medical Center
Good Samaritan Hospital Dayton
Kettering
Mercy Health West
Southern Ohio Medical Center
Genesis Healthcare System
OhioHealth MedCentral Mansfield
Marion General
Elyria Medical Center -UH
Mercy Regional Medical Center Lorain ProMedica
Bay Park
Lima Memorial Health System
Springfield Regional Medical Center
Adena Regional
Medical Center
Soin Medical Center
Upper Valley Medical Center
Licking Memorial Health System
NAS Participating Sites 2014
1/2014 start Level 3 and Level 2 teams
Akron Children’s
St. Elizabeth Health
Center/Mahoning Valley
Trumbull Memorial
4/2014 start Level 2 teams
Key Driver Diagram Project Name: OPQC Neonatal NAS Leader: Walsh
SMART AIM
KEY DRIVERS INTERVENTIONS
By increasing identification of and
compassionate withdrawal treatment for full-term infants born with
Neonatal Abstinence Syndrome (NAS), we will reduce length of stay by 20% across participating sites by June 30, 2015.
Improve recognition and non-judgmental support for Narcotic
addicted women and infants
Connect with outpatient support and treatment
program prior to discharge
Standardize NAS Treatment Protocol
Optimize Non-Pharmacologic Rx Bundle
• Initiate Rx If NAS score > 8 twice. •Stabilization/ Escalation Phase •Wean when stable for 48 hrs by 10% daily.
•Swaddling, low stimulation. •Encourage kangaroo care •Feed on demand- MBM if appropriate or lactose free, 22 cal formula
•All MD and RN staff to view “Nurture the Mother- Nurture the Child” •Monthly education on addiction care
Attain high reliability in NAS scoring by nursing staff
Partner with Families to Establish Safety Plan for Infant
Fulltime RN staff at Level 2 and 3 to complete D’Apolito NAS scoring training video and achieve 90% reliability.
• Establish agreement with outpatient program and/or Mental Health •Utilize Early Intervention Services
Collaborate with DHS/ CPS to ensure infant safety.
Prenatal Identification of Mom Implement Optimal Med Rx Program
Engage families in Safety Planning. Partner with other stakeholders to influence policy and primary
prevention. Provide primary prevention materials to sites.
To reduce the number of moms and babies with narcotic exposure, and
reduce the need for treatment of NAS.
GLOBAL AIM
Community Resources for Patients and Providers
Site 2
Presenter 2
Our Community Resources • Project Cure – Methadone Clinic. Will take pregnant women up to 29
weeks; their waiting list is usually 2-3 weeks.
• Nova House – Residential treatment. (No children allowed.) Does not prescribe Methadone or Subutex; instead focuses on the Substance Abuse Process.
• Women’s Recovery – Residential treatment facility. Women allowed to have their children with them. Associated with TCN Outpatient Clinic (Behavior Health and Addiction Services)
• Cornerstone – 3 sites in our area. Substance Abuse Rehabilitation. Outpatient setting Subutex Clinic. Will take pregnant women up to 29 weeks.
• Samaritan Behavioral Health – Mental Health and Substance Abuse Outpatient Clinic.
.
Community Resource Benefits
Patient Benefit • The need for these agencies
is great in our area. The need currently exceeds the availability.
• We have found patient involvement with these facilities often assists in increasing stability in their lives which can lead to a decrease in relapse.
Hospital/Provider Benefit • Increased support for our
patients.
• Better care for the moms and their babies.
• We have seen higher rates of
visitation from mothers who are actively involved in these support agencies.
Site 2
Presenter 2
Collaboration between the Women and Children’s Unit and
OB/GYN & Pediatric Offices
• Dedicated Women and Children’s Social Worker Time is Spilt – Beginning and end of each day and group time is in hospital – The middle of every day is dedicated to appointment
with patients in the OB/GYN or Pediatric office.
• Address Patient’s Social Problems throughout her Pregnancy (addiction, homelessness, non-custody of children, food insecurity, miscarriage, fetal demises, anxiety, depression, post traumatic stress disorder, post partum depression, NAS, child care/parenting , mandated reporting)
How addictions issues are addressed The Modified 5 Ps Referral-to LISW Assessment Explanation of Hospital
Policies 1.Hold on infant 2. Scoring 3. Cord Stats Patient Options 1. Inpatient 2. Clinics 3. Groups Addressing Social Needs
Subutex Group • Monthly Centering Meeting • Weekly Meetings • Random Drug Screens • Outside attendance of AA/NA
meetings • Journals, Feelings/ Emotions,
Gratitude Lists • Life Skills
Successes-27 Babies Born- Only 2-Pharmological Interventions
Community Partners that Benefit Patients
Addiction Related
• Scioto Paint Valley ADAMH Board *
• SPVMH/211/Crisis Center * • Ross County’s Drug Task Force • Recovery Council * • Local AA/NA Groups * • Children’s Services * • County Health Departments* • Health Recovery Services* • Stepping Stones*
*Available in Multiple Counties
Pregnancy/Family • Ross County Domestic Violence
Commission • Family and Children First
Council • Elizabeth’s Hope * • Life Centers • County Health Departments* • Help Me Grow* • WIC* • Love Inc. • Church Groups
SITE 3
PRESENTER 3
OCWTP's 8 Regional Training Centers
THE TRAINER/COACH POOL APPROXIMATELY 250 INDEPENDENT CONTRACTORS
Participant/Trainee Populations Served Through the OCWTP
Case Workers
Child Welfare
Supervisors and
Managers
Foster Caregivers
and Adoptive Parents
Training Delivery Methods Focused on Building Competency
Workshops
• Awareness, knowledge, beginning application
• Focused content
Learning Labs
• Application and skill development
• Practical application
GAPS
• Application and skill development
• Learner driven • Focused on
filling skills and knowledge GAPS
• Brainstorming and problem solving
Coaching
• 1:1 home or work site based
• Individualized plan for learner
• Skill enhancement, working toward mastery
Discussion and Questions • What has been your
experience partnering with Community Agencies?
• What barriers have you encountered in
attempting to partner with Community Agencies?
• Questions for our presenters ?
PDSA’s PDSA Key Drivers
Improved recognition and non-judgmental support for Narcotic addicted women and
infants
High reliability in NAS scoring
Non-pharmacologic bundle
Standardized NAS Treatment Protocol
Connecting with outpatient support and
treatment program prior to discharge
Partner with families to establish safety plan for
infant
Save the Date(s)!
OPQC Learning Session
• Save the Date: January 26, 2015 at the Columbus Marriott (Airport)
• PLEASE be certain to have your Social Worker
attend with your team if possible! • Opportunity to “Steal Shamelessly & Share
Seamlessly” with other teams
• Update your team contact info if changes have occurred from last January
Next Steps
• Continue testing small tests of change (PDSA) • Please submit NAS Data by November 30th.
Remember to please submit and check “No Eligible Babies for the Month” if there were no NAS patients at your site.
• Monthly Progress Report will be sent to Key Contacts this week; due NOVEMBER 30th
Happy Thanksgiving!! We are so thankful for each of YOU and your hard work and dedication to the mothers and babies you care for! Best wishes for a Happy Thanksgiving!
The OPQC NAS Project is funded by The Ohio
Department of Medicaid