The Challenge: Engaging Families during the Birth Hospitalization
Implementation of the Eat Sleep Console (ESC) tool and decreased use of pharmacologic therapy has contributed to great progress in reduction of the average length of stay for substance exposed infants within the CHoSEN Collaborative. While this care model has led to exciting outcomes, it requires significant support and time investment from both hospital providers and families, and we don’t yet fully understand how parents and caregivers are impacted by this new approach.
The Solution: Learning Directly from Families
To fill this gap, CHoSEN QIC has begun to engage birthing individuals in semi-structured qualitative interviews to better understand their birth hospitalization experience. By engaging directly with those involved, we aim to better understand the barriers and facilitators to implementing ESC and non-pharmacologic care during this time. These interviews focus on the following key areas:
Engaging in this process will allow us as a Collaborative to learn directly from those receiving this care with the goal of tailoring our interventions and approach to hospital care to best serve families.
While this work is ongoing, so far, three key areas have emerged as important for families during this time:
One participant emphasized the importance of education throughout this process by saying, “One thing has been consistent through both of my experiences, I was very surprised at how every staff member, specifically the RNs knew a significant amount about withdrawal, the adverse effects of medication vs. no medication. They were very non-biased and very informative, and they all were consistent on what they knew, you can tell the information was accurate.”
Looking to Understand the Experiences of Families at Your Hospital?
If your hospital is interested in having families who receive care at your site share their experiences, CHoSEN QIC is currently conducting interviews with birthing individuals affected by substance use. This allows us to learn directly from individuals and families who have experienced caring for an infant prenatally exposed to substances and how we can best care for them during their birth hospitalization. To learn more about this opportunity, contact Dr. Stephanie Bourque.
Dr. Bourque is a member of the CHoSEN QIC Steering Committee and is on faculty at the University of Colorado School of Medicine. Her clinical work as a neonatologist is primarily at Children’s Hospital Colorado and University Hospital. Within the CHoSEN Collaborative, Dr. Bourque’s focus is on optimizing family engagement, specifically during the birth hospitalization.
With the coronavirus (COVID-19) pandemic ongoing, multidisciplinary professionals from across the Rocky Mountain region who support families impacted by prenatal substance exposure convened virtually on October 13th to share updates and learn from each other’s successes and challenges in implementing related quality improvement efforts.
Missed the event or looking to refresh your memory of the day? Find the materials, recordings, and related upcoming opportunities to engage linked below.
Materials and Recordings:
The work continues! While our world continues to look different, the CHoSEN Collaborative team is still here to support your efforts and connect you to related initiatives.
Opportunities to Engage:
Quality improvement efforts often use the phrase “share seamlessly, steal shameless” to describe the importance of learning from one another and building from each others’ strengths and past efforts.
With that sharing philosophy in mind, we’re happy to share that our first CHoSEN article will be published in Hospital Pediatrics (Volume 10, Issue 9, September 2020). The article is titled “The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative: Standardization of Care for Opioid-Exposed Newborns Shortens Length of Stay and Reduces Number of Infants Requiring Opiate Therapy” and includes aggregated CHoSEN QIC data from April 2017 to December 2019 demonstrating our statewide collaborative’s reductions in average LOS, the percentage of OENs requiring opiate therapy, and average LOS for OENs requiring opiate therapy.
Thank you to all the participating CHoSEN hospital teams who have made this opportunity to share our work with the broader pediatric community possible!
The CHoSEN QIC team is developing additional manuscripts to continue to share our lessons and successes, including a draft manuscript analyzing demographic disparities. If your hospital team is interested in disseminating your hospital’s work--whether to your C-suite, for a conference, or for publication, support is available. Please contact Dr. Susan Hwang to get the ball rolling to seamlessly share.
Lutheran Medical Center is one of the founding hospitals of the CHoSEN Quality Improvement Collaborative. Jillian Adams, director of strategic initiatives for Illuminate Colorado sat down with Dr. Erica Wymore to discuss how she and the team at Lutheran Medical Center are utilizing their electronic health record (EHR) system to support their hospital’s CHoSEN practice changes, particularly related to breastfeeding practices.
Dr. Wymore is the Medical Director of the Newborn ICU at Lutheran Medical Center, a faculty member at the University of Colorado School of Medicine, and a member of the Steering Committee for CHoSEN QIC has been part of this effort from the beginning, continuing to innovate around supporting opioid-exposed newborns and their families.
The Challenge: Communication Across Mother and Infant Provider Teams
Examination of data across CHoSEN hospitals revealed variability among breastfeeding rates for substance-exposed newborns, leading to a desire to improve these rates among mother-infant dyads affected by a substance use disorder.
To begin addressing this need, Lutheran Medical Center worked to create a process map to help them understand, reflect on, and identify room for improvement in their policies and procedures for determining a dyad’s breastfeeding eligibility and effectively and consistently communicating it between providers and to families.
Engaging in this process led to the identification of a challenge with ensuring that important information from the mother’s medical record and provider team is reflected in the infant’s medical record and shared with the infant’s provider team.
The Solution: Ask What Your EHR System Can Do for You
With this challenge identified, the team at Lutheran began collaborating with their electronic health record provider to develop improved and automated workflows within their EHR system to ensure that important information related to a mother-infant dyad’s breastfeeding eligibility is available in all of the necessary places. Watch the interview with Dr. Wymore to learn more about how Lutheran Medical Center developed their process map and is working with their EHR provider to create new workflows.
Looking for Solutions for your Hospital?
If your site is interested in implementing similar innovations, Dr. Wymore advises developing a process map to identify your hospital’s key players and then working to provide clear and consistent education that will ensure families affected by prenatal substance exposure receive the best and most consistent care. CHoSEN QIC is able to support hospitals through these innovations by conducting a virtual site visit and helping teams with steps like developing a process map. To request and schedule a virtual site visit, contact Jessica Scott.
Addressing the Shortage of Providers in Colorado able to Prescribe Treatment for Patients with Opioid Use Disorder
For the last decade, overdose has been a leading cause of pregnancy-associated death in Colorado. Colorado providers have a unique opportunity to aid persons struggling with opioid use disorder (OUD) during the vulnerable perinatal period.
Buprenorphine can be prescribed during routine clinical care, including primary care, family practice, psychiatry, and the emergency department, to treat individuals with prescription opioid or heroin addiction, including during pregnancy and postpartum. With the increasing prevalence of maternal OUD and overdose deaths in the state, it is imperative that treatment resources for these patients increase.
However, there is a shortage of providers in Colorado who are able to prescribe buprenorphine treatment for patients with OUD, and even fewer trained to care for the perinatal population.
To address this need, the Practice Innovations in Opioid Management at the CU Department of Family Medicine is offering a stipend for Colorado providers who invest the time to take the waiver training to get their DEA X waiver. Those who complete a waiver training course and receive their waivers from DEA by September 30 will be eligible to receive up to $1000 in compensation.
Amidst the Coronavirus (COVID-19) pandemic, multidisciplinary professionals who support families with newborns prenatally exposed to substances from across the state of Colorado convened virtually on May 12th for the Spring CHoSEN Forum to share updates and learn from each other’s successes and challenges in implementing related quality improvement efforts.
Dr. Susan Hwang shared updates on the CHoSEN Collaborative’s hospital-level efforts, including the network’s growth to over 30 hospitals across three states and 2017-2020 data from hospitals within the CHoSEN cohort, including average lengths of inpatient stays for opioid-exposed newborns, percentages of opioid-exposed newborns who received pharmacologic therapy, and the racial and ethnic disparities that exist within those statistics.
Hear from subject matter experts, share your challenges and progress and learn from your colleagues at the Virtual Spring CHoSEN Forum.
Virtual Spring CHoSEN Forum
Tuesday, May 12, 2020
9:30 am - 12:30 pm
Don't miss our forum keynote:
Caring for the Opioid-Exposed Mother Infant Dyad Across the Perinatal Continuum
Davida M. Schiff, M.D.
Medical Director of the HOPE Clinic (Harnessing support for Opioid and substance use disorder in Pregnancy and Early childhood) at Massachusetts General Hospital
Virtual attendees will also have the opportunity to participate in a breakout discussion with colleagues from around the state on one of the following topics:
The Colorado Department of Human Services (CDHS) is required by key federal legislation addressing child abuse and neglect known as "CAPTA" to ensure that families with a newborn born affected by substance exposure have a "plan of safe care" that addresses both newborn and caregiver needs. Discharge of any infant exposed to substances, prescribed or illicit, should include careful planning and involvement of a multidisciplinary team.
Medical providers, child welfare professionals, and treatment providers are invited to this Plans of Safe Care Kickoff Event to learn more.
Please join representatives from Illuminate Colorado, Colorado Hospital Substance Exposed Newborn Collaborate (CHoSEN), the CDHS Office of Behavior Health and the Division of Child Welfare for presentations on Colorado's collaborative approach to engaging families with substance exposed newborns.
Discussions will focus on multidisciplinary outreach, coordination and partnership to support the implementation of the Comprehensive Addiction and Recovery Act (CARA) provisions, and the Plans of Safe Care, a requirement of Child Abuse Prevention and Treatment Act (CAPTA).
Plans of Safe Care Kickoff Event
Tuesday, March 3, 2020
9 AM to 3 PM
Summit Conference & Event Center
411 Sable Blvd.
Aurora, CO 80011
Download the agenda.
For more information contact Suzy Morris (303-866-4268 or firstname.lastname@example.org).
Areas of Focus at the event include:
Video series available for providers and family to learn more to improve the lives of newborns prenatally exposed to substances.
The CHoSEN Collaborative has create a short series of videos for inpatient providers, outpatient maternal providers and outpatient pediatric providers to learn about:
Visit the Provider Video Resource Library to choose the video series that is right for you.
The CHoSEN Collaborative has also created a patient and family-friendly video series to learn about the CHoSEN Collaborative, breastfeeding, non-pharmacologic care, safe discharge, and eat, sleep, console care for a new baby.
Share the CHoSEN family video series with your patients.
Email us if you are a provider or a hospital and you would like to embed any of the CHoSEN videos on your website.
Sincere thanks to the staff of Denver Health for providing a location to film this educational series of videos, – especially to the wonderful and compassionate staff of Denver Health’s Neonatal Intensive Care Unit.