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

5. 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

7. 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

8. 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.

9. 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.

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

11. 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.

12. 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.)

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

17. 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

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

19. 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

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

22. 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.)

23. 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

25. 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

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

27. 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

28. 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!

29. Questions now: Questions later:
Ask
Questions later:

30. Thank you. For additional information,
contact Sue Kannenberg at or
ext. 205