clOUDi 3.0 updates newsletter

October 11, 2023

In the Literature...

Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal: The mean length of time from birth until medical readiness for discharge was 8.2 days in the Eat, Sleep, Console group versus 14.9 days in the usual care group. The mean length of stay in the hospital was 7.8 days in the Eat, Sleep, Console group and 14 days in the usual care group, and the proportion of infants who received opioid treatment was 19.5% and 52%, respectively. The risk of adverse outcomes was similar in the two groups.

Considerations and Determinants of Discharge Decisions among Prenatal Substance Exposed Infants: Using a sample of patients with a history of substance use during pregnancy, this study employed a person-centered analytic approach to identify distinct subgroups distinguished by infant prenatal substance exposure (e.g., cocaine use, nicotine use), intervention type (i.e., pharmacologic plus non-pharmacologic, or non-pharmacologic only), and demographic factors (e.g., race and rurality). We then used these classes to predict the odds of infants being discharged to their biological parents versus out of home placement. Finally, using a variable-centered approach, we investigated how unique substance exposures, intervention type, and demo- graphic factors influenced placement decisions in a series of univariate and multivariate logistic regressions.

Eat Sleep Console for the Management of Neonatal Abstinence Syndrome: A Process and Outcomes Evaluation - 

Introduction: The purpose of the project was to conduct an evaluation of a practice change to Eat Sleep Console (ESC) on the postpartum unit and neonatal intensive care unit (NICU) of a Baby-Friendly® tertiary hospital.

Method: Guided by Donabedian’s quality care model, a process and outcomes evaluation of ESC was conducted through a retrospective chart review and the Eat Sleep Console Nurse Questionnaire, which assessed processes of care and knowledge, attitudes and perceptions of nurses.

Results: Improvement in neonatal outcomes including a decreased need for NICU admission (44% vs 20%; p = .022) and number of morphine doses (12.33 vs 3.17; p = .045) was noted pre- to post-intervention. Breastfeeding at discharge increased from 38% to 57%, but did not reach statistical significance. Thirty-seven nurses (71%) completed the full survey.

Discussion: Use of ESC resulted in positive neonatal outcomes. Nurse-identified areas for improvement resulted in a plan for continued improvement.

Data Reminders

1. Please ensure your clOUDi data through September 1st is entered as soon as possible
2. Please complete the final snapshot for clOUDi as soon as possible - thanks!

Sepsis in Obstetric Care now enrolling teams...

After months of work and multiple virtual meetings by our Sepsis in Obstetric Care Expert Team, we are proud to announce that work is complete (AIM/Mission statement, action plan, key driver diagram, metrics and prework) and we are prepared for launch of our Sepsis in Obstetric Care Initiative in January at our January Kickoff.

What is needed now is you and your hospital and a commitment to address the challenge that is infection in obstetric care.

Maternal death due to sepsis is fortunately relatively low, but it is reported as 11.7% of maternal mortality cases in North Carolina, and it should be lower.

This is our chance!

Please consider and discuss with your perinatal and hospital leaders the opportunity you have to reduce maternal deaths and morbidity from sepsis in your hospital. Join us on this path as we continue the mission to make North Carolina the best place to give birth and be born!

Care of the Late Preterm Infant Initiative now enrolling teams....

In January 2024, PQCNC will be kicking off an initiative to improve the care and outcomes for the late preterm infant population. In 2022, North Carolina saw over 7,500 infants born between 35-36 weeks gestation. This initiative will provide an opportunity to ensure you have an evidence based care pathway for this population as we collectively work to reduce readmissions of these infants.

Over the last few months, the expert team has worked to develop the charter, action plan/driver diagram and data collection elements for this initiative. Please take a moment to review these items as you discuss the opportunity to improve care for these infants.

This is all hands on deck! Every delivery hospital in North Carolina cares for late preterm infants and now is the chance to improve the care that is provided.

Please consider joining us on our journey…..