iNICQ 2013/2014 Ongoing Lessons

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iNICQ 2013/2014 Ongoing Lessons

Controversies in the Care of Infants and Families Affected by Neonatal Abstinence Syndrome

In 2013, the Vermont Oxford Network launched iNICQ 2013, an internet-based quality improvement collaborative designed to assist teams of obstetric and neonatal professionals to improve the quality, safety, and efficiency of care for substance-exposed newborns and their families. Although there is still considerable scientific uncertainty regarding the optimal approaches to identification, treatment and monitoring of infants with NAS, we believe that measurable improvements are possible.

In 2013 iNICQ Collaborative enrolled 205 centers from 42 states, Ireland, and the United Kingdom. In addition to the Core Curriculum, the Intensive arm of the collaborative enrolled 48 centers, who took a “deeper dive” by exploring not just “what”, but “how” to implement care practices to improve the quality, safety and value of care for this vulnerable population.

The 2014 iNICQ Collaborative enrolled 143 centers from 32 states, Canada and Ireland. State Collaboratives from Massachusetts, Michigan and New Hampshire are using VON’s Core and Intensive curriculums in developing statewide quality improvement efforts.

Measurement of Center-Wide Performance and Progress to Date

The measurement arm of the collaborative utilized the VON Days Quality Audit/Neonatal Abstinence Syndrome, and a web-based portal for data entry to identify opportunities for improvement. Over 90% of the iNICQ 2013 participating centers collected baseline measures. The data from 180 centers, including 1032 infants is the largest audit of NAS to date, and revealed significant variability in the care of this population and clear opportunities for improvement.

The audit was repeated 6 months into the collaborative to assess early progress toward goals. The most recent audit, including 170 participating hospitals, revealed that 22% still do not have standardized policies on screening for maternal substance use. Although participating centers have made some progress, moving from 77 to 83% in developing comprehensive policies and guidelines for the evaluation and treatment of substance-exposed infants, 17% have not yet developed such policies. Some progress has been seen, including improvements in implementing educational programs to standardize NAS severity scoring – a key driver of both pharmacologic treatment and length of stay increased 12%; policies standardizing pharmacologic treatment increased 6%; and policies related to the use of human milk increased 5%; however, baseline rates still suggest potential underutilization of human milk in this population.

Continuing Education Credits  / Maintenance of Certification Part 4

The educational offerings associated with iNICQ 2013/2014 have been approved for Continuing Medical Education and Nursing Contact Hours credit. To date, over 3500 credits have been awarded from the iNICQ 2013 collaborative. The educational materials have been archived on NICQpedia and are accessible to collaborative participants 24/7 for a period of 3 years. Ongoing CME/NCH credit is available for viewing these presentations.

The iNICQ 2013 Collaborative is approved for Maintenance of Certification Part 4 credit following criteria established by the American Board of Pediatrics. Individual physicians and groups who meet the criteria established by the American Board of Pediatrics are using the iNICQ 2013 Collaborative as a source of Maintenance of Certification (MOC) Part 4 credit as they work to improve the care of infants and families affected by Neonatal Abstinence Syndrome.

Learn more about continuing education opportunities.

Centers that participated in 2013, as well as new centers are invited to extend this collaborative work into 2014 / 2015. VON will provide ongoing curricular offerings and serial measurement of each center’s progress. Rolling admissions will be accepted and new teams will have access to all of the 2013 and 2014 collaborative materials.

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