A Quality Improvement Initiative to Increase Scoring Consistency and Accuracy of the Finnegan Tool: Challenges in Obtaining Reliable Assessments of Drug Withdrawal in Neonatal Abstinence Syndrome
UMass Chan Affiliations
Graduate School of NursingDepartment of Quantitative Health Sciences
Department of Pediatrics, Division of Neonatology
Document Type
Journal ArticlePublication Date
2017-10-17Keywords
Finneganneonatal abstinence syndrome assessment
neonatal substance withdrawal
newborn infants
opioids
Maternal, Child Health and Neonatal Nursing
Pediatrics
Substance Abuse and Addiction
Metadata
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BACKGROUND: Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs. PURPOSE: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses. METHODS: One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale. Nurses scored a standardized video-recorded infant presenting with opioid withdrawal before and after training. RESULTS: Nearly twice as many nurses scored at target (Finnegan score of 8) posttraining (34.7%; mean error = 0.559, SD = 1.4) compared with pretraining (18.8%; mean error = 1.31, SD = 1.95; Wilcoxon, P < .001). Finnegan scores were significantly higher than the target score pretraining (mean = 9.31, SD = 1.95) compared with posttraining (mean = 8.56, SD = 1.40, Wilcoxon P < .001); follow-up assessments reverted to pretraining levels (mean = 9.16, SD = 1.8). Score dispersion was greater pretraining (variance 3.80) compared with posttraining (variance 1.96; Kendall's Coefficient, P < .001) largely due to score disparity among central nervous system symptomology. IMPLICATIONS FOR PRACTICE: Education, clinical guidelines, and a restructured scoring tool increased consistency and accuracy of infant withdrawal-assessments among neonatal nurses. However, more than 60% of nurses did not assess withdrawal to the target score immediately following the training period and improvements did not persist over time. IMPLICATIONS FOR RESEARCH: This study highlights the need for more objective tools to quantify withdrawal severity given that assessments are the primary driver of pharmacological management in neonatal drug withdrawal.Source
Adv Neonatal Care. 2017 Oct 17. doi: 10.1097/ANC.0000000000000441. Link to article on publisher's siteDOI
10.1097/ANC.0000000000000441Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43615PubMed ID
29045256Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/ANC.0000000000000441