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dc.contributor.authorTimpson, Wendy
dc.contributor.authorKilloran, Cheryl
dc.contributor.authorMaranda, Louise
dc.contributor.authorPicarillo, Alan
dc.contributor.authorBloch-Salisbury, Elisabeth
dc.date2022-08-11T08:10:13.000
dc.date.accessioned2022-08-23T16:59:34Z
dc.date.available2022-08-23T16:59:34Z
dc.date.issued2017-10-17
dc.date.submitted2017-11-27
dc.identifier.citationAdv Neonatal Care. 2017 Oct 17. doi: 10.1097/ANC.0000000000000441. <a href="https://doi.org/10.1097/ANC.0000000000000441">Link to article on publisher's site</a>
dc.identifier.issn1536-0903 (Linking)
dc.identifier.doi10.1097/ANC.0000000000000441
dc.identifier.pmid29045256
dc.identifier.urihttp://hdl.handle.net/20.500.14038/43615
dc.description.abstractBACKGROUND: 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 video-recorded 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=29045256&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttps://doi.org/10.1097/ANC.0000000000000441
dc.subjectFinnegan
dc.subjectneonatal abstinence syndrome assessment
dc.subjectneonatal substance withdrawal
dc.subjectnewborn infants
dc.subjectopioids
dc.subjectMaternal, Child Health and Neonatal Nursing
dc.subjectPediatrics
dc.subjectSubstance Abuse and Addiction
dc.titleA 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
dc.typeJournal Article
dc.source.journaltitleAdvances in neonatal care : official journal of the National Association of Neonatal Nurses
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/peds_pp/187
dc.identifier.contextkey11154100
html.description.abstract<p>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.</p> <p>PURPOSE: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses.</p> <p>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 video-recorded infant presenting with opioid withdrawal before and after training.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathpeds_pp/187
dc.contributor.departmentGraduate School of Nursing
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Pediatrics, Division of Neonatology


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