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Albert Einstein College of Medicine ​hello everyone my name is Sally so bill Radke and i am a doctorate of Nursing Practice student at the University of South Alabama College of Nursing the following is a presentation of my quality improvement project my project was an examination of how the implementation of a substance abuse educational in service improved neonatal intensive care unit nurses perspectives towards opioid addicted mothers and decrease the length of stay for infants hospitalized for intrauterine exposure to maternal opioids withdrawal in infants exposed to inter uterine drugs specifically opiates has become a worldwide epidemic with one infant born every hour showing signs of withdrawal infants born to mothers with a history of prenatal drug abuse have higher rates of NICU admissions secondary to immediate withdrawal behaviors or necessary continued observation for potential withdrawal infants born following intrauterine drug exposure usually began exhibiting signs and symptoms of withdrawal in the first 48 to 72 hours after delivery since the 1970s neonatal abstinence syndrome or Nass has been a diagnosis given to infants withdrawing from maternal opioid use Nass is a consortium of symptoms specific to infants experiencing withdrawal from intrauterine drug exposure mainly opioids studies have focused on the nurses ability to properly utilize scoring systems for necessary medical interventions for infants experiencing Nass literature has debated as to which pharmacological intervention is superior for the chemical intervention for infants with Nass from 2012 to project completion time in 2015 there had been an increase of one to two babies per six months with neonatal abstinence syndrome admitted into the neonatal intensive care unit at the quality improvement site for Patrick et al in 2012 the average length of stay for an infant with Nass was at 16 days at a cost of 3400 dollars per hospital day the length of stay for infants with an ass was 18 point five days at the project site which was 2.5 days greater than the national average the background of this quality improvement project is as follows research has suggested nurses perspectives towards opioid addicted mothers can impact the bonding between the mother and her newborn increased training and education of nurses related to substance abuse has been found to improve nurses knowledge and enhance mother infant bonding health care workers in general tend to have negative perspectives towards patients who use and abuse substances it has long been established that NICU nurses tend to have negative perspectives towards pregnant women who use illicit substances can be judgmental and are lacking in knowledge regarding substance abuse adversarial nurses perspectives have been shown to be a barrier in the promotion of effective maternal infant bonding studies have established rooming in an increased time spent between the opioid addicted mother and her infant has decreased the length of stay for infants with neonatal abstinence syndrome opioid addicted mothers who spend additional time with their infants are better equipped to understand the specific care their infant requires however despite the evidence many NICU is have not provided supplementary educational programs for nurses to enhance their understanding of substance abuse a component of total quality management benchmarking is a continuous process by which an organization can measure compare its own processes with other organizations that are leaders in a particular area in 2014 the Vermont Oxford Network published the following benchmarking statement to create a culture of compassion understanding and healing for the mother-infant diet affected by NASA the National Quality forum in 2012 stated patient family and caregiver experiences are to be related to quality and safety improvements the Northeast neonatal benchmarking group in 2006 noted staff are to be trained and supported to promote a nonjudgmental attitude towards care and to raise awareness of this population in 2001 the Institute of Medicine stated care needed to be patient centered and equitable for all the mission statement of the quality improvement project site is to respond with excellent service respect and compassion in 2011 the American Nurses Association recognized more needs to be done on the topic of substance abuse and published the policy statement as follows nurses in maternal child services may not be fully educated in the needs of patients with substance abuse problems and the special needs of infants experiencing Nass nurses are encouraged to seek educational programs offering additional training in mental health and drug addiction fields in 2001 the american nurses association published their code of ethics the nurse establishes relationships and delivers nursing services with respect for human needs and values and without prejudice an individual's lifestyle value system and religious beliefs should be considered when planning health care with and for each patient such consideration does not suggest the nurse necessarily agrees with or condone certain individual choices but that the nurse respects the patient as a person a question was constructed for the doctorate of Nursing Practice quality improvement project utilizing the Pico format with the implementation of a substance abuse educational in service improved the knowledge and perspectives of NICU nurses towards opioid


addicted mothers and decrease the length of stay for infants with neonatal abstinence syndrome the project purpose and goals to improve NICU nurses knowledge and perspectives towards opioid addicted mothers following a substance abuse educational program to decrease the length of stay of infants with Nath's after the presentation of an educational in service on substance abuse and to assist in the benchmarking attainment and decrease financial expenditures related to the care of infants with Nass institutional review board approval was granted at the project site and at the University of South Alabama the NICU for the project was located in a suburb outside a metropolis with a population of approximately seven hundred thousand people seventy-five percent of the NICU staff were in the age range of 56 to 70 years and had greater than 20 years of NICU background experience focus groups were held to determine neonatal nurses perspectives on substance abuse knowledge and current care practices staff involvement allows ownership and can facilitate the change process individual group members need opportunities for autonomy and ownership of project changes focus groups can propose discussions related to perceptions beliefs and attitudes regarding a particular topic information gained from the focus groups was utilized to tailor a 60 minute educational presentation on substance abuse for the NICU RN staff the implementation tools utilized to measure those perspectives towards substance abuse and parenting for the attitudes towards drug use and parenting survey and the substance abuse attitude survey both of these tools have been shown to be valid and reliable created in 1999 the attitudes toward drug use and parenting survey is a 20 question survey specific to drug use and parenting and utilize the substance abuse attitude survey as a developmental template the substance abuse attitude survey created in 1985 is based on personal opinions and experiences of health care workers to measure attitudes regarding general substance abuse and uses more statements than the attitudes toward drug use and parenting survey it has the answer choices of agree or disagree both of the tools were adapted for specific use of this quality improvement project by the doctorate of Nursing Practice project manager and author an educational in service on substance abuse was created and presented to the NICU RN staff utilizing the information gained from the focus groups the substance abuse educational in service contained a segment of Nico RN statements regarding their feelings towards opioid addicted mothers which was obtained from published literature the NICU RN statements were compared with statements from the opioid addicted mothers on their perspectives well be in the NICU as a parent providing the bridge between the RNs and opioid addicted mothers statements was a neurophysiology segment regarding opioid addiction due to the sensitive nature of statements on attitude surveys towards substance abuse participants were asked to sign the consent form but not submit these to the doctorate of Nursing Practice project manager to assure privacy and allow full autonomy in truthful survey completion all pre and post intervention attitude no surveys contain no identifiers to guarantee confidentiality and protect the NICU RN participants participants were given the option of attending the substance abuse educational in service without completion of the substance abuse attitude surveys pre and post-tests questionnaires have been documented as successful tools in the evaluation process pre and post intervention surveys were analyzed to measure changes in perspectives following the substance abuse educational in service post intervention surveys were again distributed at six months to measure changes in perspectives over time also length of stay for infants with nance was tracked for 12 months prior to and six months following the intervention of the substance abuse educational in service neonatal nurses showed overall improvement on post intervention surveys towards substance abuse immediately following the substance abuse in service the nurses continued to show improvement on post intervention surveys towards substance abuse at six months following the intervention of the substance abuse in service performance outcomes were measurements of knowledge and perspective changes of the NICU RNs as evidenced by improvement on post intervention attitudinal surveys summative impact evaluation measuring longer-term outcomes were demonstrated by knowledge and perspective changes over time and postintervention attitude surveys in comparison of length of stay for infants diagnosed with NASA at the conclusion of the project this slide highlights the most dramatic changes which occurred immediately following the substance abuse educational in service and also demonstrates continued improvements in NICU nurses perspectives over a six-month time period as you can see by the statement selected there is an eighty-two percent increase in a statement of helping opioid addicted mothers is worthwhile with one hundred percent of participants agreeing with the statement at six months the statement of opioid addicted mothers are capable of behavioral change showed an increase in forty-five percent with 91% of participants agreeing with the statement at six months the statement of opioid addicted mothers created their own problems showed an increase of third seven percent with nine percent in agreement of the statement at six months compared to forty six percent in agreement with the statement pre-intervention the statement of opioid addicted mothers are deceitful unreliable and uncooperative showed a twenty-three percent change with seventythree percent of participants disagreeing with this statement by six months during data collection prior to the substance abuse educational in service a total of ten infants were treated for Nath's in the NICU the average length of stay


during this time for these ten infants was 18 point five days at an approximate cost of 63,000 dollars per infant following the substance abuse educational in service over a time period of six months seven infants were admitted and treated for NASA in the NICU for total of 114 days the average length of stay for infants admitted to the NICU for withdrawal treatment greater than five days was 16 point three days demonstrating a decrease of 2.2 hospital days the projected cost savings as a result of this quality improvement doctorate of Nursing Practice intervention project was eight thousand dollars per infant the results of this quality improvement doctorate of Nursing Practice project the NICU nurses improved their knowledge and perspectives and were more in alignment with the benchmarks and policy statements the overwhelming attendance at the educational in service by the vast majority of NICU staff as well as labor and delivery staff exhibited a unified interest by our ends regarding the topic of substance abuse the financial impact of this quality improvement project was realized by decreasing the length of stay by two point two days over a six-month time period which is more in alignment with national averages and showed a cost savings of eight thousand dollars per infant the conclusion and the practice implications nurses have the ability to positively impact the bonding of the opioid addicted mother and her infant nurses can positively influence the length of stay for infants with Nass nurses desire to expand their knowledge base regarding the topic of substance abuse future recommendations for outcomes to remain sustainable additional knowledge would be beneficial utilizing this substance abuse educational in service as the foundation for further knowledge building ongoing provision of research and literature to the NICU staff regarding substance abuse would be useful to complement existing knowledge as with supplementary in services on substance abuse new RN staff orienting to the NICU would benefit from the substance abuse educational in service as a component of their orientation materials although not a part of this quality improvement project patient satisfaction surveys from opioid addicted mothers could have been an additional metric to further assist in the determination of long-term success and project sustainability I hope you enjoyed my doctorate of Nursing Practice quality improvement project presentation I want to thank you very much for your time and attention State University of New York at Cobleskill.

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