Strategies to Improve the Quality of Team-Based Care for Neonatal Abstinence Syndrome

Abstract

BACKGROUND Prioritizing nonpharmacologic care for neonatal abstinence syndrome (NAS) requires a team-based care (TBC) approach to facilitate staff and family engagement. We aimed to identify the important structures and processes of care for TBC of infants with NAS and quality of care outcomes that are meaningful to care team members (including parents). METHODS Using a Donabedian framework, we conducted semistructured interviews from May to October 2019 with care team members at 3 community hospitals, including parents, nurses, social workers, physicians, lactation nurses, child protective services, volunteers, and hospital administrators. We used thematic analysis to identify important structures, processes of care, and outcomes. RESULTS We interviewed 45 interprofessional care team members: 35 providers and 10 parents. Structures critical to providing TBC included (1) building a comprehensive network of interprofessional team members and (2) creating an NAS specialized unit. Necessary processes of care included (1) prioritizing early involvement of interprofessional team members, (2) emphasizing nonjudgmental incorporation of previous experience with addiction, (3) establishing clear roles and expectations, and (4) maintaining transparency with social services. Lastly, we identified 9 outcomes resulting from these identified structures and processes that are meaningful to care team members to assess the quality of care for infants with NAS. CONCLUSIONS In this study, we identify important structures, processes of care, and meaningful outcomes to enhance and evaluate TBC for infants with NAS. Hospitals that adopt and implement these structures and processes have the potential to improve the quality of care for infants, caregivers, and providers who care for these infants.

Neonatal intensive care nurses' accounts of care for mothers/families with substance‐exposed pregnancies: A critical discourse analysis

“…Evidence suggests that interactions with mothers/families (Fraser et al, 2007; Maguire et al, 2012; Murphy‐Oikonen et al, 2010; Welborn et al, 2022; Whittaker et al, 2016), collaborations with other providers (McDaniel et al, 2021; Welborn et al, 2022), patient satisfaction (Flagg, 2015) and opportunities for self‐care (Bodenheimer & Sinsky, 2014; Sikka et al, 2015) all impact how nurses provide care, particularly via workload. Nurses' experiences of caring for an infant and family with an SEP support the experiences described by postpartum nurses when caring for infants and mothers with an SEP and OUD from Reese et al (2021) and expand upon the increased workload related to acuity and complex family situations previously discussed by Smith et al (2018).…”

“…Family‐centered care (FCC) is a primary tenet in neonatal healthcare, with parents valued as integral members of the healthcare team and where decisions are made collaboratively to improve outcomes of care (Gooding et al, 2011; McDaniel et al, 2021; Ramezani et al, 2014). It is expected that all members of the NICU team engage in FCC as a primary function of their role (Gooding et al, 2011).…”

“…These, and other factors, may impact individual nurse workload, team dynamics and/or nurse experiences. No matter the organization of the NICU team, a comprehensive and integrated team of nurses, physicians and interprofessional experts is key to promoting improved patient outcomes, experiences of care (McDaniel et al, 2021) and building a supportive work setting (Jeffs, 2018).…”