NAS Universal Training Program

Improving Outcomes for Infants and Families Affected by Neonatal Abstinence Syndrome (NAS) – A Universal Training Program

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After completion of our highly successful iNICQ focused on Neonatal Abstinence Syndrome (NAS) VON is now continuing the quest to improve care for substance-exposed infants and families, through the launch of two new resources.

  • NAS Universal Training Education Package – available for individuals, centers, or health systems focused on harnessing the power of universal training and standardizing NAS care.read more
    These resources include:
    • NAS Universal Training Program – including 18 critical Micro-Lessons relevant to every caregiver who provides care to substance-exposed infants and women, and presented by 35 world-class NAS experts – available 24/7 on-line with CME, CNE pharm-eligible credits.
    • A VON Improving NAS Toolkit.
    • A 5-Chapter Virtual Video Visit and Facilitators Guide, to a Center of Excellence in NAS Care – highlighting the trauma-informed approach to care that has yielded tremendous success in other settings.
    • Sample policies, procedures, guidelines and family educational tools essential for NAS Care.
    • Over 100 NAS-related quality improvement stories, and data – showing real-world examples of measurable improvement in length of stay, length of treatment and cost – while improving satisfaction.
  • NAS Statewide / Health System Implementation Package – now available to Statewide Perinatal Quality Improvement Collaboratives, health systems, hospitals and individuals will benefit from the enduring value of this educational program available on demand on VON’s Learning Management System. Investment in this collaborative was likely cost-saving for states that supported center engagement. Using 2012 approximations, we estimated that reducing the hospital LOS by 2 days nationwide would result in a savings of a projected $170 million in hospital charges. Click here for more details on statewide programs.

Background – Understanding NAS and the Opioid Epidemic

Every 25 minutes an opioid-exposed infant is born at risk for neonatal abstinence syndrome (NAS). Many NICUs, step-down units, and newborn nurseries are struggling to care for this medically fragile and socially complex population. read more

Over the last decade, the number of prescriptions written for opioids grew substantially. According to the Centers for Disease Control and Prevention, in 2012, an estimated 259 million prescriptions were written in the United States, enough for every American adult to have one bottle of pills. As more Americans used opioids, complications such as adult overdose deaths and NAS increased.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome experienced by infants exposed to opioids, or narcotic drugs like oxycodone, while in utero. NAS has been linked to both illicit drug use as well as prescription opioids — narcotic pain relievers such as hydrocodone — by pregnant women. Infants born with NAS are more likely to have respiratory complications, feeding difficulty, low birthweights, and extended hospital stays.

What is NAS Universal Training?

Providing high-reliability care requires developing standardized clinical processes. Universal educational programs apply the principle of standardization to education. The power of universal educational programs, such as NRP and others, is that the training provides a solid foundation upon which to standardize care.

What Are the Components of the NAS State Implementation Package?

The VON designed and tested NAS Universal Training Program includes state-of-the art evidence-based content from leading experts in NAS care, including the author of the AAP Guidelines, Dr. Mark Hudak, and 35 of the leading worldwide experts in neonatal care. read more

By subscribing to the NAS Universal Training Program your center, health system, or state will be able to provide access to critical education and improvement tools to every provider! These resources include:

  • NAS Universal Training Program – including 18 critical Micro-lessons relevant to every caregiver who provides care to substance-exposed infants and women, and presented by 35 world-class NAS experts – available 24/7 on-line with CME, CNE pharm-eligible credits.
  • A customizable VON Improving NAS Toolkit – ready for your team to add the state specific context, branding and key statewide AIMS for improving NAS care.
  • A 5-Chapter Virtual Video Visit and Facilitators Guide, to a Center of Excellence in NAS Care – highlighting the trauma-informed approach to care that has yielded tremendous success in other settings.
  • Statewide Data and Reporting – Statewide perinatal collaboratives may elect to use the VON Day Quality Audits for NAS. This data reported at the center and state level, will provide a useful gap analysis and benchmarks to inform statewide improvement efforts and track progress throughout your improvement cycle.
  • Sample policies, procedures, guidelines and family educational tools essential for NAS Care.
  • Over 100 NAS-related quality improvement stories, and data – showing real-world examples of measurable improvement in length of stay, length of treatment and cost – while improving satisfaction.

What Results Have the 200+ VON Centers Achieved?

Prompted by the alarming statistics the American Academy of Pediatrics released a policy statement in 2012, calling for standardizing care for infants with NAS. That same year, Vermont Oxford Network, a non-profit dedicated to improving the quality and safety of medical care for infants and their families, launched the multi-center quality improvement collaborative focused on rapid-cycle adoption of these important practice guidelines. read more

Since 2013, over 200 leading teams from VON have been focused on systematically implementing the AAP guidelines for the care of infants and families affected by NAS. Working collaboratively these teams have made major strides in standardizing practice by adopting evidence-based policies and developing innovative service models for mothers and infants across the trajectory of care. In 2015, 110 centers including five statewide quality improvement collaboratives focused on adopting the VON Universal Training Solution for NAS in an effort to deliver highly reliable care to every patient, every time. The five statewide collaboratives are:

  • Alaska – Alaska State Collaborative – State Leader: Lily Lou MD
  • Massachusetts – Neonatology Quality Improvement Collaborative (NeoQIC) – State Leaders: Munish Gupta MD & Alan Picarillo MD
  • Michigan – Michigan Collaborative Quality Initiative (MICQI) – State Leader Padu Karna MD
  • New Hampshire/Vermont – Northern New England Perinatal Quality Improvement Network (NNEPQIN) State Leaders: William Edwards MD, Victoria Flanagan RN & Bonny Whalen MD
  • Wisconsin – Wisconsin Neonatal Perinatal Quality Collaborative (WINpqc) State Leaders: Sue Kannenberg RHIA, Jeff Garland MD & Janice Ancona MSN, RN

To date, 45 centers have achieved the VON Center of Excellence in NAS Education and Training Designation. Click here for a list of these centers.

VON Published Results – Pediatrics 2016

The initial results of the VON Quality Improvement effort are published in the following paper:

Patrick SW, Schumacher RE, Horbar JD, Buus-Frank ME, Edwards EM, Morrow KA, Ferrelli KR, Picarillo AP, Gupta M, Soll RF. Improving care for neonatal abstinence syndrome. Pediatrics. 2016; 137(5): e20153835. PubMed: 27244809

read more

“Many of the hospitals implemented simple and inexpensive strategies, such as swaddling, soothing, skin-to-skin contact with mothers and breastfeeding to prevent escalation of withdrawal symptoms in the first few days after birth. This translated into decreased use of additional narcotics and sedatives to control withdrawal symptoms, and avoided the need for costly admission to a newborn intensive care unit,” said Madge Buus-Frank, DNP, Executive Vice President and Director of Quality Improvement and Education at Vermont Oxford Network.

The evidence of better outcomes, the study authors conclude, reinforces the need to continue to standardize the care provided to infants with NAS and to explore ways to make care more efficient and family centered.