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Welcome to the OPQC NAS
October Action Period Call
• Thank you for joining;
our webinar will start
shortly!
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sign in the chat box
with the names of all
webinar participants and
hospital affiliation.
Neonatal Abstinence
Syndrome Project
October Action Period Call
Ohio Perinatal Quality Collaborative
October 2015
Welcome!
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Group Mute To ask a question:
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into the Chat Box
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MUTE (and *6 to go back on).
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Time Topic Presenter
12:00 pm Welcome & Agenda Review
Learning Session Highlights
Andrea Hoberman, MPH
12:10 pm Data Overview Heather Kaplan, MD
12:25 pm Phase 2: New Data Measures & Collection Forms
Learning Lab Structure for Groups 1-4
Andrea Hoberman
12:35 pm New Data SharePoint Functionality Dan Jeffers, MS
12:45 pm Team Discussion – Q&A All teams
12:55 pm Next Steps
•Data Submission Reminder
•MPR/PDSA Reminder
•Learning Lab Calls
Andrea Hoberman
Agenda
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Learning Session Highlights
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3
3
4
5
10
10
12
17
0 5 10 15 20
MCO
Finnegan Scoring
Data Collection
Flow Charts
Reliability
Other
PDSAs
Formula Info
What one strategy that you heard today will you want to test or
implement at your site? (n=66)
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Key Driver Diagram Project Name: OPQC Neonatal NAS Leader: Walsh
SMART AIM
KEY DRIVERS INTERVENTIONS
By increasing identification of and
compassionate withdrawal treatment for full-term infants born with
Neonatal Abstinence Syndrome (NAS), we will
reduce length of stay by 1 day across participating sites by June 30, 2016.
Improve recognition and non-judgmental support for Narcotic
addicted women and infants
Connect with outpatient support and treatment program prior to
discharge
Standardize NAS Treatment Protocol
Optimize Non-Pharmacologic Rx Bundle
Initiate Rx If NAS score > 8 twice. Stabilization/ Escalation Phase Wean when stable for 48 hrs by 10%
daily.
Swaddling, low stimulation. Encourage kangaroo care Feed on demand- MBM if appropriate
or lactose free, 22 cal formula
All MD and RN staff to view “Nurture the Mother- Nurture the Child”
Monthly education on addiction care
Attain high reliability in NAS scoring by nursing staff
Partner with Families to Establish Safety Plan for Infant
• Fulltime RN staff at Level 2 and 3 to complete D’Apolito NAS scoring training video and achieve 90% reliability.
Establish agreement with outpatient program and/or Mental Health
Utilize Early Intervention Services
Collaborate with DHS/ CPS to ensure infant safety.
Prenatal Identification of Mom Implement Optimal Med Rx Program
Engage families in Safety Planning. Partner with other stakeholders to influence policy and primary
prevention. Provide primary prevention materials to sites.
To reduce the number of moms and babies with narcotic exposure, and
reduce the need for treatment of NAS.
GLOBAL AIM
Collaborative Aggregate Data Submission
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% Infants that Received ANY Non Pharmacologic Elements Before Drug Treatment
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% Non Pharmacologic Bundle Compliance
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Distribution of Non-Pharmacologic Care Elements Received Before Drug Treatment (Purple)
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% Infants that Received Pharmacologic Treatment
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% Pharamacologic Bundle Compliance
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Distribution of Pharmacologic Treatment Elements Received (Pink)
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Average Length of Opiate Treatment
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Average Length of Stay for Pharmacologically Treated Babies
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OPQC NAS Phase 2 Timeline
July Aug Sept October-June July
Hospitals commit to participate
Sites self select to 1 of 4 formula groups
Test & finalize Data Collection Form
Test & finalize Data Collection Instructions
Call with Lead Physicians (August)
Learning Session—
PROJECT KICK OFF
Run OT Testing
“Learning Lab” AP Calls
Quarterly Action Period Group Calls
Data Collection & Submission
Continued work on other Key Drivers
Analyze Results
Update &
Implement Best
Care Practices
Phase 2 data collection
begins with babies born
after 10/1/15
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Orchestrated Testing Measures
• Measures that are not changing:
– Length of stay for pharmacologically
treated infants
– Length of opiate treatment for
pharmacologically treated infants
– Percent of infants treated
pharmacologically
• Each of these measures will continue on from
the beginning of the collaborative with an
annotation for the start of the Orchestrated
Testing phase
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Orchestrated Testing Measures
• New or redesigned process measures:
– Non-pharmacologic bundle compliance
• Adding 22 kcal/oz formula for sites that are in groups that are
using 22 kcal/oz formula
• Only including low lactose feeding for sites that are in groups
that are using low lactose formula
– Percent of infants receiving low lactose
feeding/Percent of infants receiving 22 kcal/oz feeds
• New measures for site and Orchestrated Testing group levels
– Percent of infants fed breast milk
• New measure for all levels
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Orchestrated Testing Measures
• New outcome measures: – Length of stay for all infants
• We will now be collecting length of stay for all babies whether they
are treated pharmacologically or not
– Percent of infants requiring a dose escalation or failing a
weaning step
• This will use data from the first phase of NAS in addition to the new
Orchestrated Testing data collection form to give us a run chart
starting in January 2014
– Percent of infants with >10% weight loss
• Severity of withdrawal
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Orchestrated Testing Measures
• New balancing
measures:
– Highest Finnegan score
in 24 hours prior to
starting treatment
– Number of Finnegan
scores >12 in 24 hours
prior to starting
treatment
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New/Phase 2 Data Collection Paper form: OPQC does NOT
collect this form. All data must be entered electronically. Sites are
encouraged to use the paper to collect their data prior to entry. This form can
be found on the OPQC SharePoint member sign in page. www.opqc.net
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Eligibility
Any infant ≥37 weeks gestational age at birth with IN UTERO opioid
exposure and with the diagnosis of Narcotic Abstinence Syndrome
(NAS) who is identified after birth and is being monitored for signs and
symptoms of opiate withdrawal with the Finnegan scoring system.
Infants may be inborn or outborn and transferred to a participating center
after birth. Infants may be born outside the state of Ohio.
Exclusion Infants who were only exposed to opioids postnatally are not included
in this study.
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What if I don’t have any eligible babies for a calendar
month? (calendar month based on the baby birth month)
1. Fill in the Checkbox and indicate the Month/Year you did not have any babies
2. Once the data entry system is ready – you will check this box and hit Submit
3. Do not fill out the rest of the form
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If no, please answer Question #2A and #2B The following data will be collected on OUTBORN (transferred in) babies.
• DOL was baby transferred to your hospital
• Type(s) of NAS treatment or support at the transferring hospital
• The DOL treatment started at the transferring hospital
• A few details on the NAS treatment at the transferring hospital
• How was the baby fed at the transferring hospital
***If the baby was
Inborn – please
skip this section
and proceed to
Question #3
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Question #4: Baby birth weight
please record in grams
Question #5: Record the baby’s lowest weight in the
first 7 days of life
please record in grams
Baby’s Weight
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Maternal Drug Exposure
Question #6 - 11: Questions in this section ask about mom’s exposure to
drugs or tobacco during this pregnancy and include greater detail than
questions found on the Phase 1 Data Collection Form
Additional questions include:
• Is mom actively in a drug treatment program
• Drug exposure to prescribed opiates
• other than treatment program opiates
• you can find a list of opiates in the data instruction
document
• Drug exposure to heroin
• Drug exposure to illicit opiates
• other than heroin
• Drug exposure to other drugs not listed above
• you can find a list of other drugs in the data instruction
document
• Did mom smoke tobacco cigarettes during this
pregnancy
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Additional detail regarding Non-Pharmacologic
Treatment (at your hospital)
Question #13: Indicate how this baby was fed at your hospital (check all that apply)
– Formula, Breast Milk or Other type of feed
– For each type of feed
• Complete calorie content and indicate DOL start and DOL stop
• If the feed was low lactose, indicate DOL start and DOL stop
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Pharmacologic Treatment (at your hospital)
Question #14: Did the baby receive pharmacologic treatment at
your hospital?
– Yes, No or Can’t Determine
• If yes: additional questions include:
– Finnegan score >12 and the highest score in the 24 hours prior to starting
pharmacologic treatment on this baby
– When was treatment initiated and was the primary drug used?
– Did you follow your hospital NAS protocol for this baby? • Please review your hospital protocol to respond to questions in this section
– Was a dose escalation necessary? If yes when?
– Did the baby fail a wean step?
– Did the baby follow your hospitals NAS treatment weaning schedule?
– Was a secondary medication used? If yes, what medication and when did
you initiate it?
– Was this baby discharged on drug to treat NAS? If yes, which drug and
how long was the baby treated?
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OPQC Orchestrated Testing Groupings
Group 22 kcal/oz
Standard
Low Lactose
Standard
1 Yes Yes
2 Yes No
3 No Yes
4 No No
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Learning Lab Calls
Group 1 – 2nd Wed at 2pm
Group 2- 2nd Wed at 1pm
Group 3 – 3rd Wed at 2pm
Group 4- 3rd Tues at 3pm
October – Quarterly Action Period Call
Nov 11 at 2pm Nov 11 at 1pm Nov 18 at 2pm Nov 17 at 3pm
Dec 9 at 2pm Dec 9 at 1pm Dec 16 at 2pm Dec 15 at 3pm
January – Quarterly Action Period Call
Feb 10 at 2pm Feb 10 at 1pm Feb 17 at 2pm Feb 16 at 3pm
March – OPQC Spring Learning Session
April – Quarterly Action Period Call
May 11 at 2pm May 11 at 1pm May 18 at 2pm May 17 at 3pm
June 8 at 2pm June 8 at 1pm June 15 at 2pm June 21 at 3pm
July – Quarterly Action Period Call
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Poll Question
Have you had the opportunity to
use the new Phase 2 Data Collection Form?
– Yes
– No, we’ve not yet collected data for babies
born since 10/1
– No, we’ve not had any NAS babies since 10/1
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Technology Updates
Online reporting
Dan Jeffers
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What’s new?
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What’s still coming?
• Online reporting instead of pdf
• Daily data refresh
• Chart display flexibility
• Simplified workflow
• One stop shopping
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Report Settings
• Display options
• Measure
• Start/end dates
• Y-axis min/max
• Hospital, group, region
• Show/hide centerline, goal line
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LIVE DEMO
OPQC NAS Reports
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An example…
• Interested in aggregate LOT since June
2014
Let’s drill
down
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Drilling in…
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What stays the same?
• OPQC portal/web site
• User name/password
• Data security
• Report layout
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But wait, there’s more
• Planned enhancements
• Ability to create pdf on demand
• Annotation capability
• Your suggestions
• Send suggestions/wishes to
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What if I need help?
• Tip sheet distributed at the OPQC
9/28 Learning Session
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Questions??
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Next Steps • Invites for group specific Learning Lab Calls
were emailed on October 21st. Please attend!!
• Please use the Phase 2 Data Collection Form for all
NAS babies born on/after October 1st.
• Please submit NAS September Data (as well as data
prior to September) ASAP. Remember to please
submit and check “No Eligible Babies for the Month”
if there were no NAS patients at your site.
• Monthly Progress Report was be sent to Key
Contacts last week; due October 30th.
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The OPQC NAS Project is
funded by The Ohio
Department of Medicaid
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