Initial Effective Date
TITLE / Neonatal Abstinence Management
NUMBER / FMC-Dept-NICU-PC-PE-110 / Last Revised/Reviewed Effective Date: / June 2012
TJC FUNCTIONS / PC-PE
Applies to / FMC (Main) – Nursing Division, NICU
I. / SCOPE / PURPOSE
Guidelines for the management and cohorting of infants experiencing withdrawal symptoms. Applies to NBN, NICU, and Pediatric Units.
II. / POLICY
A. If there is a known or suspected maternal history of drug use or if the maternal history is not known but symptoms of withdrawal are present:
· Notify medical practitioner to order urine and meconium screens if not already done.
· Notify social worker.
· Notify lactation consultants.
· Start neonatal abstinence scoring (NAS) every three to four hours (with feedings) and do a clinical evaluation of symptoms.
B. Full-term infants may remain in newborn nursery during mother’s hospitalization and nursery nurses will complete NAS scoring.
C. NAS patients will be admitted to the pediatric unit for abstinence monitoring if no confounding factors exist (prematurity, acute sepsis, etc) when NAS scores are 8 or after maternal discharge. Infants born to mothers with a history of drug abuse or methadone use during pregnancy who do not exhibit signs/symptoms of withdrawal will be monitored in the pediatrics unit for approximately one week.
1. NAS patients in the pediatrics unit will remain under the care of the neonatology medical team.
2. If NAS pediatric census is greater than 2, two nurses or a nurse and a care partner will staff the unit.
3. NAS patients will remain in NICU if census is greater than staffing allows or if a medical diagnosis is present that requires intensive care monitoring.
4. NAS infants receiving a course of antibiotic treatment may be monitored in the pediatrics unit as per guidelines for other infant transfer to the pediatric unit (see ADMISSION CRITERIA AND PLACEMENT, NICU policy).
5. NAS infants will be placed 1 or 2 per pediatric room. Maximum number of pediatric NAS patients is 8.
6. If staffing or room availability is unable to accommodate the NAS patient(s), those infant will be placed in the NICU.
D. NAS patients in the NICU
1. NAS patients remaining in the NICU for reasons of other medical diagnosis will be placed in rooms as indicated by medical condition.
2. Attempts will be made to cohort these infants in a quiet area or place in a single bed room.
E. Monitoring and Treatment
1. Infants exhibiting symptoms of withdrawal or under a one week observation for withdrawal symptoms may be placed in the pediatric unit without continuous monitoring unless certain factors are present.
2. Continuous cardiorespiratory monitoring is required if:
a. Infant is receiving other treatment such as antibiotics for sepsis.
b. Infant is in acute phase of medication regimen (new or increasing doses).
c. Infant is receiving clonidine treatment.
3. Continuous cardiorespiratory monitoring may be discontinued with a physician order if conditions requiring monitoring are no longer present or if infant has stabilized on a steady or weaning dose of morphine.
4. Vital signs, assessments and scoring will be done at feeding times for minimal disruption of withdrawing infant.
F. Parent Education and Interaction
1. Parents of NAS infants may room in (in pediatric unit) with baby if census/room availability allows.
2. Parents of NAS infants will be encouraged to spend extended periods of time with the infant, caring for infant and assisting in comfort measures.
3. Kangaroo care will be strongly encouraged. Kangaroo care increases bonding and provides comfort to infants.
4. Breastfeeding will be strongly encouraged (unless contraindicated medically).
III. / QUALIFIED PERSONNEL
RNs, LPNs, Care Partners in the NICU, NBN, and Pediatric units
IV. / EQUIPMENT
n/a
V. / PROCEDURE
The procedure serves as a guideline to assist personnel in accomplishing the goals of the policy. While following these procedural guidelines personnel are expected to exercise judgment within their scope of practice and/or job responsibilities.
VI. / DOCUMENTATION
All nursing documentation is done in the infant’s electronic medical record or on downtime sheets if electronic record is not available.
VII. / DEFINITIONS
NAS: neonatal abstinence syndrome
Kangaroo Care: skin-to-skin holding
VIII. / RELATED DOCUMENTS
NICU policies:
NEONATAL ABSTINENCE SYNDROME TREATMENT
ADMISSION CRITERIA AND PLACEMENT
BACK TO SLEEP
CLUSTER CARE AND MINIMAL STIMULATION
KANGAROO CARE
TRANSFER TO NEWBORN NURSERY OR PEDIATRICS
DISCHARGE OF INFANTS TO ADOPTION OR FOSTER CARE
DISCHARGE PROCESS
NICU STANDING ORDERS AND PROTOCOLS
PAIN EVALUATION/NIPS
NICU Best Practice Manual
Pediatric Unit policies related to care of infants
Newborn nursery policies related to NAS infants
IX. / REFERENCES
X. / SUBMITTED BY
NICU Developmental Care Committee
Lisa Hurley, RN-C, Policy and Procedure Committee
XI. / KEY WORDS
NAS, abstinence, drug withdrawal, morphine, clonidine
XII. /
INITIAL EFFECTIVE DATE
/ 6/2012DATES REVISIONS EFFECTIVE
DATES REVIEWED (no changes)
Date due for next review
/ 6/2015Signature Sheet (one copy only to be maintained by author)
Company / Facility(s)
/ FMC (Main)Department(s) / Nursing Division-NICU, Newborn Nursery, Pediatric Unit
Title of document / Neonatal Abstinence Management
Action / Initiated
Approved By:
Title / Approved By / Signature / Date
Medical Director, NICU / Mario A. Rojas, MD / 06/25/2012
Nurse Manager, NICU / Sandy Day, RN-C / 06/18/2012
Director, Women’s Center / Ann Smith, RN, NNP-BC / 06/25/2012
Nurse Manager, Pediatric Unit / Jane Sherrill, RN / 06/18/2012
Nurse Manager, Mother/Baby and Newborn Nursery / Belinda Hankins, RN / 06/18/2012
Committees Approved By:
Committee / Chairperson/Designee / Date
NICU Best Practice / Mario A. Rojas, MD / 06/25/2012
NICU UCIC / Jennifer Hudson, RN / 06/06/2012
NICU Policy and Procedures / Lisa Hurley, RN-C / 06/06/2012
POLICY/PROCEDURE / Neonatal Abstinence Management / Page 1 of 4