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Presented by Pam Fisher and Tamara Dowless
Carolinas Medical Center - Pineville
Teaching parents to recognize key signs and symptoms of narcotic abstinence can lead to shorter hospital stays, promote more effective and successful care of these babies at home, and minimize readmissions.
} Establish trust with the parents and enlist them as partners; Trust is essential for collaboration
} Empower the parents with knowledge and confidence; they are an extension of the care the baby receives in the hospital
} Teach the parents how to respond to their baby’s special needs and minimize symptoms
} Ensure that educational tools are easy to use and appropriate for their level of Health Literacy
} Recognize the parent’s journey } Encourage breastfeeding / skin to skin care } Facilitate visitation } Share information
} Encourage longer periods of visitation rather than frequent short visits
} Establish goals for the visits ◦ What are the parents expectations? ◦ What are the healthcare team’s expectations?
} Coordinate departmental consultations during the extended visitation times
} Develop a “Care Contract” } Encourage parents to call for phone updates
when they are unable to visit
Sample Medical Contract To be printed on hospital letterhead
Care Contract for Parents of ___________________________
(insert infant name here) Visitation Schedule (check all that apply)
��� Between the dates of _____________ the following should be completed:
��� _____ full days of visitation in NICU (at least 6 hours at the bedside) (list possible dates here ________________)
��� _____ overnight stays (depending on unit census) (list overnight dates here _______________) Discharge teaching will be complete prior to your baby going home. This will include infant CPR and basic infant care. These sessions can take place during your visitation as listed above, but before any overnight stays outside of your baby’s room. Skills Required for Discharge (Check all that apply)
��� Demonstrate effective comfort measures and caring taking techniques. ��� Demonstrate knowledge of medication needs and ability to give medication properly, including appropriate dosing. ��� Verbalize and recognition signs and symptoms of withdrawal. ��� Verbalize when to call pediatrician. ��� Verbalize when to call 911.
Discharge Referrals **This section is to be individualized to each infant’s needs. See example below.** Home Health RN and PT visits will begin the day after discharge. Babynet referral is in place for long term developmental follow. They will also make home visits. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Barriers / Concerns Please list any concerns or barriers to completing this contract (for example, work schedule or transportation). Our team will work with you to connect you with the appropriate resources. ____________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________ _______________________________________ ________________ Parent Name Parent Signature Date _______________________________________ _______________________________________ _______________ Hospital team member name (MD, MSW, NNP) Hospital team member signature Date Patient Sticker
} Basic Knowledge – how is their baby different } Measuring behaviors – simple tools for
tracking and treating } Prevention – techniques to minimize
symptoms } Intervention – when to get help
} Typical newborn care } Basic principles of using the Finnegan
Neonatal Abstinence Scoring Tool (FNAST) } Identifying common symptoms their baby
displays
} Help parents to identify typical newborn behavior (i.e. Purple Crying)
} Discuss the baby’s score as determined with the Finnegan Neonatal Abstinence Scoring Tool
} Highlight NAS symptoms that are most common for each individual baby
} Common measures used include: ◦ Sleep ◦ Crying ◦ Shaking ◦ Diarrhea
◦ Sneezing ◦ Yawning ◦ Sucking / Feeding ◦ Spitting
Time of Feeding
Breast feeding (total # minutes)
Bo6le feeding (total # cc)
Time of stool (loose or watery?)
Time fell asleep
Time woke up
Time and # of sneezes
Time of yawn
Excessive suck and not hungry
Parent Comments
Example: 12:15 pm L – 15 min
R – 10 min cc 1:30 pm loose
9:00 am 12:00 pm 12:30 pm 3 sneezes
12:45 pm Yes Was fussy as just had her vaccine. BreasGed great.
Baby’s symptom diary: L -‐
R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
L -‐ R -‐ cc
Baby’s Symptom Diary
Baby’s Name: ______________________________ Baby’s Med Record #:____________________ Date: _______________
} Low lights } Sound control - avoid loud noises, TV, loud
conversations, banging doors, etc. } Hold/gently rock baby } Skin to skin/kangaroo care } Swaddling
} Facilitate a “rooming in” experience; a minimum of 2-3 days is optimal
} Utilize the “rooming in” time to ensure understanding of teaching using “Teach Back”
} Encourage and praise their efforts; provide them with specific feedback
} Reinforce what to watch for at home
} Ask Me 3: 1) What is my baby’s main problem?
____I understand ____ I need more guidance 2) What do I need to do about it?
____I understand ____I need more guidance 3) Why is it important for me to do this?
____I understand ____I need more guidance
} Teach Back: ____Able to verbalize/demonstrate ____Needs more guidance
} The care of these children requires a complete team of healthcare providers INCLUDING THE PARENTS and extensive education for families.
} When successful, these children go home sooner and parents can perform more confidently in their roles.
