Nursing Perceptions of Transition to Eat, Sleep, Console for Neonatal Abstinence Syndrome in the Newborn Nursery

Background: Hospitals nationwide have recently began transitioning from the Finnegan Neonatal Abstinence Scoring System (FNASS) to the Eat, Sleep, Console (ESC) method for assessing neonatal abstinence syndrome (NAS) symptoms and aid in determining thresholds for treatment with opioids. Though many centers have transitioned to the NAS method, there is a paucity of literature on staff perceptions of this method and opportunities for optimization, particularly for nursing staff.

Methods: A survey was distributed to the nursing staff of the mother-baby unit at UNC Hospitals with questions assessing perceptions of ESC, staff support, and care delivered. All responses were voluntary and anonymous. The unit transitioned to ESC in January 2019, and survey responses were elicited November 2019 and January 2021.

Results: A total of 32 nurses completed the survey in 2019 and 22 in 2021. All respondents had cared for an infant utilizing ESC, though the number that had experience with FNASS decreased from 72% (n=23) in 2019 to 59% (n=13) in 2021. Utilizing a scale of 1 to 5 (1 being most negative, 5 being most positive) over the two time periods, respondents similarly rated the clarity of orders with ESC (3 vs. 3.1) and the ease of transfer to the inpatient unit when NAS symptoms were escalating (2.9 vs 3). Between 2019 and 2021, perceptions trended toward improvement regarding provider support when concerned for an infant with NAS (3.2 [1.2] vs. 3.9 [0.7]). At both time periods, roughly 80% of nurses who had utilized both FNASS and ESC felt that their therapeutic relationship was the same or improved utilizing the ESC and 85% reported being pleased with the care they deliver utilizing ESC. The majority of comments expressed desire for a mechanism to more concisely document ESC assessments as FNASS scores were an EPIC flowsheet/calculator.

Conclusion: After a major transition in the assessment for infants with NAS in the mother-baby unit to ESC, the majority of nurses responding to a survey both one and two years after implementation responded positively regarding the care they delivered and the therapeutic relationship they were able to develop with the patients. Areas for improvement include improving documentation methods and continuing to improve processes for assessment and escalation of care when infants are experiencing increasing withdrawal symptoms.