PC1120: Implementation of a Nurse-driven Eat-sleep-console (ESC) Treatment Pathway at a Community Hospital for Treatment of Neonatal Abstinence syndrome (NAS)

Background: Recently, the Chandler Regional Medical Center (CRMC) Neonatal Intensive Care Unit (NICU) began a phased implementation of an Eat-Sleep-Console (ESC) management pathway for those at-risk for Neonatal Abstinence Syndrome (NAS). The CRMC ESC implementation and care process is unique as it has been mainly nurse led and managed; beginning at initial enrollment and pre-delivery consultation to significant nursing involvement in ESC cares (especially when parents are not available or uninvolved). The purpose of this study is to track short-term outcomes as well as the program’s effect on nursing workflow and job performance rating/satisfaction.

Methods: A retrospective review of the ESC implementation process at CRMC from the years 2018-2020 was performed. All infants >35 weeks admitted to the NICU solely for management of NAS were included. The study consisted of 3 epochs corresponding to each calendar year: Epoch 1 (2018) – traditional pharmacologic management; Epoch 2 (2019) – parent-led ESC management; Epoch 3 (2020) – parent/nurse-led ESC management. Length of stay (LOS), treatment pathway assignment, and proportion of infants treated with pharmacologic agents were compared between the 3 epochs. Student's t-test (continuous) and Fisher's exact test (categorical) statistical analyses were used as appropriate.

A web-based (REDCap) survey of NICU nursing staff was created consisting of a series of questions with answers requiring ratings based on a Likert scale to measure nurses’ perceptions and attitudes towards the ESC program and the management of infants with NAS.

Results: Epoch 1: 48 patients (0 ESC), 32 (67%) received pharmacological treatment(s), average LOS 18.4 days. Epoch 2: 30 patients (16 ESC), 11 (37%) received pharmacological treatment(s), average LOS 10.5 days (ESC - 6.9 days, non-ESC - 14.6 days). Epoch 3: 30 patients (30 ESC), 6 (20%) received pharmacological treatment(s), average LOS 9.3 days. Average LOS and proportion of pharmacologically treated infants decreased between
Epoch 1 and Epoch(s) 2/3 (p < 0.02).

A total of 37 nurses completed the survey with a near equal distribution of those working primarily days (51%) and nights (49%). 94% of nurses reported being comfortable (agree/strongly agree) caring for ESC patients with 89% feeling supported in their ESC nursing assignments and only 11% stating that caring for ESC patients alters their other nursing care processes. Most nurses feel (1) comfortable co-managing ESC patients with parents/caregivers, (2) parental participation has improved (compared to traditionally treated infants), and (3) families of ESC treated infants are adequately prepared for discharge with positive short-term outcomes.

Conclusion: Implementation of an ESC treatment program for infants with NAS significantly decreased LOS and the proportion of infants treated pharmacologically. This phased implementation process was not associated with self-reported negative nursing perceptions of the program and its treatment goals/outcomes.