A Quality Improvement Initiative to Increase Scoring Consistency and Accuracy of the Finnegan Tool Challenges in Obtaining Reliable Assessments of Drug Withdrawal in Neonatal Abstinence Syndrome

作者：Timpson Wendy; Killoran Cheryl; Maranda Louise; Picarillo Alan; Bloch Sali**ury Elisabeth^*

来源：Advances in Neonatal Care, 2018, 18(1): 70-78.

DOI：10.1097/ANC.0000000000000441

• Finnegan
• neonatal abstinence syndrome assessment
• neonatal substance withdrawal
• newborn infants opioids

Background: Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs.
Purpose: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses.
Methods: One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale. Nurses scored a standardized videorecorded infant presenting with opioid withdrawal before and after training.
Results: Nearly twice as many nurses scored at target (Finnegan score of 8) posttraining (34.7%; mean error = 0.559, SD = 1.4) compared with pretraining (18.8%; mean error = 1.31, SD = 1.95; Wilcoxon, P <.001). Finnegan scores were significantly higher than the target score pretraining (mean = 9.31, SD = 1.95) compared with posttraining (mean = 8.56, SD = 1.40, Wilcoxon P <.001); follow-up assessments reverted to pretraining levels (mean = 9.16, SD = 1.8). Score dispersion was greater pretraining (variance 3.80) compared with posttraining (variance 1.96; Kendall's Coefficient, P <.001) largely due to score disparity among central nervous system symptomology.
Implications for Practice: Education, clinical guidelines, and a restructured scoring tool increased consistency and accuracy of infant withdrawal-assessments among neonatal nurses. However, more than 60% of nurses did not assess withdrawal to the target score immediately following the training period and improvements did not persist over time. Implications for Research: This study highlights the need for more objective tools to quantify withdrawal severity given that assessments are the primary driver of pharmacological management in neonatal drug withdrawal.

• 出版日期2018-2