This approach, called the "Eat, Sleep, Console” (ESC) approach, is just one component of a comprehensive family-centered non-pharmacologic care approach, and has resulted in less medication treatment in the context of QI projects. While we believe the infant should continue to be assessed for signs of opioid withdrawal with a tailored treatment approach, the ESC method’s sole principle is that the pharmacologic treatment of the infant should be primarily based on infant function and comfort, as opposed to reducing all signs of opioid withdrawal. This method of assessing infants with NAS was developed by a collaborative effort between faculty at Yale, Children’s Hospital at Dartmouth-Hitchcock, and Boston Medical Center for quality improvement purposes.
The NeoQIC Human Milk QI Collaborative was a 3-year long collaborative of 10 of 10 level 3 NICUs in Massachusetts, that occurred from January 2015 until December 2017. We focused on increasing provision of mother’s milk use for very low birth weight infants and reducing racial/ethnic disparities in mother’s milk use. We worked closely with family members, the Massachusetts Department of Public Health, the Massachusetts Breastfeeding Coalition, and the Mother’s Milk Bank Northeast. In addition to local improvement work, we also developed a variety of QI educational tools for local teams and written and video education materials for families. We entered the sustainment phase in January 2018.
Reducing nosocomial infections and central-line associated bloodstream infections was the first NeoQIC collaborative quality improvement initiative, bringing all 10 Massachusetts NICUs together to share strategies, compare data, and learn from each other. The initial project extended from 2006 to 2015, and as a group, we saw a reduction in nosocomial infection and CLABSI rates in our NICUs of over 60%.
We are excited to announce that we are relaunching this project in 2018. In addition to renewed efforts to reduce nosocomial infection rates even further, we will also examine the critical issue of antibiotic usage and stewardship in our NICUs.
NeoQIC and MPQC have been working on NAS and opioid use in pregnancy for some time, and we formally joined together in this work last year as PNQIN. Thus far, most of our attention has focused on the care of the substance-exposed newborn and the family after birth. Based on great work that has already been done at several centers, we’d like to now dig deeper into collaborative efforts focused on the mother and the care of OUD in pregnancy. We’re planning a similar model to what MPQC and NeoQIC have used in the past: hospital and outpatient improvement teams and improvement projects, data sharing, a webinar QI training series, and poster presentations at our PNQIN statewide summits. We are collecting a couple maternal-focused metrics, including one of our primary outcomes of percent of mothers receiving MAT during pregnancy, and we hope to add additional obstetric-focused measures over time. There are a number of infant based measures as well, extending into the year after delivery. We should be able to use the same REDCap system for all of our data sharing.
Sudden infant death syndrome(SIDS) is the leading cause of post-neonatal mortality in the U.S. and Massachusetts. Although preterm infants are at higher risk for SIDS, safe sleep practices are rarely integrated into the routine clinical care of these infants. The American Academy of Pediatrics (AAP) defines safe sleep as supine sleeping positioning in a safety approved crib without positioning devices and free of quilts, comforters, and other soft surfaces.
The Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC) and the Massachusetts Perinatal Quality Collaborative (MPQC) are excited to launch a joint statewide quality improvement initiative focused on improving the care of infants and families impacted by perinatal opioid use and neonatal abstinence syndrome. This initiative builds upon years of past improvement work by NeoQIC, MPQC, and hospitals throughout the state, and relies on close collaborations with many state organizations, including the Department of Public Health, the Bureau of Substance Abuse Services, the Department of Children and Families, Early Intervention, and the Health Policy Commission.
The Neonatal Quality Collaborative of Massachusetts Respiratory Care Collaborative (NeoQIC RCC) was launched in December 2019 with the aim of reducing the rate of Chronic Lung Disease (CLD)/Bronchopulmonary Dysplasia (BPD) among preterm infants in Massachusetts. Our goals are to combine the power of the efforts taking place at member hospitals, support the use of improvement science, compare benchmarking data, and learn from one another as we go forward. We have begun by sharing outcomes and practices, and are progressing to structured improvement efforts within each unit using rigorous QI methods and collaborative learning.