WisPQC Informational Webinar for NAS/NOWS Initiative October 31, 2018 12:00-1:00 p.m. GoToWebinar®

NAS Infants in Wisconsin The rate of NAS in Wisconsin increased from 2 to 8.7 per 1,000 live births from 2006 – 2014; this equates to a 335 % increase. 583 infants per year reported in 2014; this equates to 6 NAS cases per year per birth hospital. Take Away: under-reporting of NAS diagnosis. Source: WI DHS

Goals of the Grant Increase the capacity of WisPQC Strengthen the data infrastructure Improve identification of infants at risk for NAS/NOWS and standardize treatment Improve identification of women with opioid use disorder Improve care of women with opioid use disorder

Background: History of the grant CDC released RFP for “State-based Perinatal Quality Collaboratives” in early 2017. WAPC, in collaboration with other partners, discussed possible directions for the proposal. WAPC submitted proposal to CDC in April 2017. WAPC notified of selection for funding in August 2017. NAS/NOWS project development occurs fall 2017 – 2018. The Wisconsin Perinatal Quality Collaborative (WisPQC) was founded in 2014 by WAPC and other partners committed to improving perinatal care and health using a strong evidence base and quality improvement science. WisPQC’s early development was supported by a grant from Wisconsin’s Department of Health Services. In 2017, the CDC released a notification of funding opportunity for “State-based Perinatal Quality Collaboratives.” The purpose of the funding was to support states to enhance the capacity of their PQCs in early development (≤ 6 years) to improve perinatal care by actively conducting QI projects that improve maternal and infant health. The total project period was five years with funding up to $200,000 per year. WisPQC members considered a range of possible clinical initiatives, weighing the strengths and weaknesses of each in the context of the current needs and resources available in Wisconsin. Members finally decided to commit the proposal to the topic of opioids in the perinatal period, identifying the needs of both infants and women as the proposal’s focus.

Background: History of the grant Enrollment of 6 Pilot Hospitals in July 2018 to test materials and focus on data collection. Recruitment & hiring of Q.I. Project Manager occurs May-August 2018. Invitation of Wisconsin birth hospitals to participate in NAS/NOWS Project begins September 2018. NAS/NOWS informational meeting occurs October 31, 2018. Maternal project development to begin January 2019.

Goal of NAS/NOWS Initiative: Improve identification of infants with NAS/NOWS and standardize treatment.

Expected Outcomes Improvements in service delivery for identifying and managing infants with NAS/NOWS Improvements in perinatal measures related to identification and management of infants with NAS/NOWS You saw the goal earlier, “Improve identification of infants at risk for NAS/NOWS and standardize treatment.” As a result of work in this initiative, we expect to see these two general outcomes.

Outcome Measures Number/percent of infants at risk for NAS/NOWS evaluated with validated tool Number/percent of infants treated using standardized protocol Number of infants with NAS/NOWS Number of infants transported/transferred for higher level of care Duration of treatment (total) for NAS/NOWS Duration of pharmacologic treatment for NAS/NOWS Length of hospitalization How are we going to know if we’re making progress, if things are improving? We identified a handful of outcome and balancing measures that we think are important considerations. (We’ve also identified a number of process measures, but those aren’t shown here.)

Standardized Protocol Identify resources Identify infants at risk Implement non-pharmacological strategies Evaluate symptoms Implement pharmacological strategies Plan for discharge

https://wispqc.org/

Data Elements Maternal Medical record number Date of birth Race County of residence Date of first and number of prenatal visits Payer Substance use Discharge disposition

Data Elements Infant Medical record number Date/time of birth Birthplace Date/time admission

Data Elements Infant’s hospital course Standardized protocol used Screening tool used Clinical signs of NAS/NOWS Management Feeding Behavioral/environmental strategies Treatment Medications Iatrogenic

Data Elements Infant discharge Destination Date/time of discharge Medications Feeding Developmental follow-up

Learning Collaborative Monthly meetings using GoToWebinar® Follow-up to items from previous meeting Review aggregate data for measures Updates from participants (successes, challenges, questions, comments, etc.)

Evaluation Process Learning Collaborative and initiative infrastructure (short-cycle PDSA) Implementing the initiative (short- and medium-cycle PDSA) Seeking of regular feedback from participants with goal of meeting the needs of all

Next Steps Who should be part of your team? Project champions include: Data Contact Nursing Pharmacist Physician Others = Social Work, Dietician, Occupational Therapy, Physical Therapy, Speech Therapy, Spiritual Care Complete the Web-based enrollment form

https://wispqc.org/nas-nows-initiative-enrollment/ Or, by going directly to the application. Again, the deadline is June 29.

Upcoming Webinar Meetings: Invite your team of opioid project champions to gather together Weekday Date Time Topic Wednesday Nov 7 12:00– 1:00 pm Standardized Protocol Tuesday Nov 13 Data Collection & Reports Nov 27 Change Package Thursday Dec 6 Eat, Sleep, Console Dec 12 Learning Collaborative Sessions: Schedule & Format Nursing

NAS/NOWS Kick-Off Meeting: Wednesday, January 9, 2019 10:00 am – 12:00 noon Reserve a room Notify team members of the date and time Create excitement about the start of this project!

Questions now: Questions later: Ask Questions later: kannenberg@perinatalweb.org

Thank you. For additional information, contact Sue Kannenberg at kannenberg@perinatalweb.org or 608-285-5858 ext. 205