P0704 - A Quality Improvement project to increase parental knowledge about Neonatal Abstinence Syndrome.

Background:
The number of newborns diagnosed with neonatal abstinence syndrome (NAS) has increased more than 10-fold in Florida since 1995, far exceeding the three-fold increase observed nationally. In 2019, our Neonatal Intensive Care Unit (NICU) joined the Florida Perinatal Quality Collaborative to help standardize NAS management and decrease neonatal length of stay. One of the key drivers of this project was to improve caregiver education on NAS. Our institution had no formal process for providing parental education. Since then, we have implemented a series of steps to improve the quality and rates of parental counselling.

Objectives: Our specific, measurable, attainable, relevant, and time-limited aim was to increase the rates of parental counseling on NAS management from 0% to 50% by June 2020.

Methods:
We developed a team consisting of providers, nurse educators and nurse leaders in quality. We identified primary key drivers to improve parental counseling before infant is transferred to NICU. The objective was to improve parental participation in management of infant NAS.

PDSA 1: Starting April 2019, the core group of providers started counseling parents of at-risk infants. Simultaneously, we created a smart phrase in the electronic records to be able to document the counseling, thereby making our aim measurable.
PDSA 2: Due to lack of consistency between the providers, we designed a standardized handout with NAS information as a resource for parents that outlined how they can contribute to their infant’s care.
PDSA 3: In order to engage providers outside the core group, we organized an educational conference for resident physicians on core aspects of NAS counseling.

Results:
We performed chart reviews to identify the proportion of eligible parents who were counseled. Following the initiation of counseling by core group, we were able to counsel 20% of eligible parents in the first two months. However, the rates dropped in June and July due to lack of structured counseling process. We started using NAS handouts after which the rates of counseling increased over the next three months to 65%. We attempted to increase the providers who can counsel these families by organizing peers to peers educational conference. The counseling rates increased remarkable to reach ninety percent in January and overall, 70% counseling rate by the end of March of 2020.
Conclusions
Our multi-step efforts led to improved rates of parental education regarding NAS. Involving all available providers may further improve the counseling rates. Consecutively, this may lead to improved parental participation in infant care with improved short and long term outcomes.