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: 

• The prenatal experience, including receipt of prenatal counseling
• The birth hospitalization itself, including interactions with the healthcare team and benefits and challenges of using ESC
• The transition from hospital to home, including follow-up care and anticipated challenges. 

 
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:

• Setting clear and upfront expectations for how families can be successful during the birth hospitalization with their infant
• Engaging in shared-decision making when pharmacologic treatment or transfer to the NICU may be needed
• Preparing families for what to expect upon discharge and referring them to relevant community resources. 

 
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.” ​

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.

Additional Resources:

• To learn more about all of CHoSEN’s key drivers, including breastfeeding, check out CHoSEN’s provider education videos here. 
• Breastfeeding guidelines from American Academy of Pediatrics can be found here and guidelines from the Academy of Breastfeeding Medicine can be found here.

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. ​

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:

• Prenatal Engagement: Share lessons and challenges around engaging patients prenatally, including using the new CHoSEN family videos.
• Breastfeeding: Share lessons and challenges around implementing policies to increase the use of mother’s own milk for opioid-exposed newborns.  
• Non-Pharm Approaches/ESC: Share lessons and challenges around the implementation of non-pharmacological approaches, including the Eat Sleep Console Assessment. 
• Plans of Safe Care: Share lessons and challenges around discharge planning and warm handoffs between hospital providers, primary care providers, child welfare, and community resources.  
• Dissemination & Publication: Discuss opportunities to share your work--whether with your C-suite, local news, conferences, peer-reviewed journals, and more.   

Don't wait! Register today!

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). 

The CHoSEN Collaborative has create a short series of videos for inpatient providers, outpatient maternal providers and outpatient pediatric providers to learn about: 

• CHoSEN Collaborative
• Breastfeeding
• Non-Pharmacologic care
• Safe Discharge
• Prenatal Consultation and 
• Eat Sleep Console Provider Training.​

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.