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.

"Colorado doctors are changing the way they care for these babies," reports CBS Denver anchor Britt Moreno. Moreno interviewed Colleen M Wheeler, a specialist in Neonatal-Perinatal Medicine with Lutheran Medical Center, a CHoSEN Collaborative participating hospital, about change in practices to support newborns exposed to Opioids, as well as trends in Denver. CHoSEN Collaborative hospitals are implementing best practices to support families of newborns prenatally exposed to substances throughout the Rocky Mountain region. 

Moreno also sat down with a mother of two to talk about her experience being pregnant and trying to combat addiction in the hopes of reducing stigma surrounding getting treatment.  

Watch the video below or read the original story on CBS4 Denver

DENVER, CO (November 27, 2019) —  Nearly 50 percent of Colorado births occur in a hospital participating in a quality improvement collaborative, coordinated by a group known as the Colorado Hospital Substance Exposed Newborns Collaborative (CHoSEN Collaborative), to improve outcomes for newborns prenatally exposed to substances. Previous publicly reported cases of Neonatal Abstinence Syndrome (NAS) in Colorado had been found to increase by 120 percent from 2011 to 2016 based on hospital discharge coding data. NAS is a group of withdrawal symptoms resulting from the sudden discontinuation of fetal exposure to substances that were used by the woman during pregnancy. Among participating hospitals, the prevalence of prenatal opioid exposure in newborns has been found to be nearly double that of publicly reported estimates.
 
Dr. Susan Hwang, the physician champion of the CHoSEN Collaborative and neonatologist at Children’s Hospital Colorado and University Hospital, attributes the increase to a change in the way patients are identified as a result of practice changes. “We have the opportunity as providers not only to improve our practice while engaging families in the care team, but also to improve measurable outcomes for newborns and families impacted by substance use during pregnancy,” said Hwang.
 
The CHoSEN Collaborative has been leading the effort to increase consistency in implementation of best practice approaches in the identification of and response to newborns prenatally exposed to substances in the Rocky Mountain region since 2017. Multidisciplinary hospital-based improvement teams track data and achieve measurable improvements for infants and families impacted by substance use.
 
Hwang shared CHoSEN Collaborative’s aggregate data at a quarterly forum organized by the CHoSEN Collaborative earlier this month, demonstrating a drastic decrease in length of stay for opioid-exposed newborns and an increase in prenatal counseling and service referrals for families. Over seventy clinicians from hospital newborn intensive care units and mom and baby units from Colorado and Wyoming gathered in Glenwood Springs, Colorado to share best practices around caring for women and newborns impacted by substance use, especially opioids.
 
“We have reduced the average length of stay for a newborn from more than two weeks to just six days, and the percent of opioid-exposed newborns being treated with opiate medications has declined from nearly 70 percent to less than 10 percent,” said Hwang.
 
Among the CHoSEN forum participants, Laurale Cross, the administrative director of the Women and Children Services Department at Valley View Hospital, located in Glenwood Springs. “When you are located in a small place, it is difficult to be aware of best practices and stay up to date on the latest research. That is one of the most important things the CHoSEN Collaborative does for hospitals,” shared Cross. 
 
Seventeen birthing hospitals are committed to the CHoSEN Collaborative Quality Improvement Collaborative. The best practice approaches include: training on behavioral techniques to sooth babies experiencing withdrawal symptoms, as an alternative to prescribing opiates; providing tools for creating safe discharge plans; and guidelines for safe breastfeeding for mothers impacted by substance use, especially opioids.    
 
The CHoSEN Collaborative is coordinated and led in partnership by the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force, chaired by Illuminate Colorado, and in collaboration with the Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and the Colorado Perinatal Care Quality Collaborative.
 
“We know from experience that collaborative action is most effective in achieving healthier outcomes for moms and babies,” shared Jaime Cabrera, executive director of the Colorado Perinatal Care Quality Collaborative (CPCQC), Colorado’s maternal and infant care quality network.
 
“We are continuing to drive a conversation around reducing barriers and stigma to accessing care for families impacted by substance use disorders in practice and policy during the upcoming legislative session in Colorado,” said Jade Woodard, executive director of Illuminate Colorado and co-chair of the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force. It will take all of us—clinicians, advocates, and most importantly families—to ensure our policies and practices are building systems to strengthen families,” said Woodard.

Hospitals participating in CHoSEN Quality Improvement Collaborative include:

• Denver Health Medical Center
• Lutheran Medical Center
• McKee Medical Center
• UCHealth Medical Center of the Rockies
• UCHealth Memorial Hospital
• North Colorado Medical Center
• North Suburban Medical Center
• Parker Adventist Hospital
• Parkview Medical Center
• Platte Valley Medical Center
• UCHealth Poudre Valley Hospital
• Rose Medical Center
• Saint Joseph Hospital
• San Luis Valley Regional Medical Center
• St. Mary’s Medical Center
• St Vincent Healthcare
• UCHealth University of Colorado Hospital

 
​Professionals not associated with a participating hospital are also encouraged to access resources available at www.chosencollaborative.org, including a New FREE tool gives Colorado perinatal providers access to hundreds of resources related to perinatal substance use paid for through a grant from the Colorado Department of Public Health and Environment.
 
Colorado Perinatal Care Quality Collaborative (CPCQC) is a statewide nonprofit network of hospitals, healthcare facilities, clinicians and public health professionals that improves the health of women and infants through continuous quality improvement. Visit cpcqc.org to learn more.
 
Illuminate Colorado is a statewide nonprofit organization building brighter childhoods through education, advocacy, and family support to prevent child maltreatment. Visit IlluminateColorado.org to learn more.

The CHoSEN Collaborative convenes a forum twice a year to foster idea-sharing and community collaboration for professionals working on improving outcomes for women and families affected by perinatal substance use and Neonatal Abstinence Syndrome (NAS). This year, the fall forum was held in Glennwood Springs, Colorado to better accommodate Western Slope attendees.  

More than seventy attendees began their day hearing CHoSEN QIC updates directly from subject matter experts Dr. Susan Hwang, Assistant Professor of Pediatrics, Neonatologist Children’s Hospital Colorado and University Hospital; CPCQC Executive Committee  Member, SEN Steering Committee Member Jaime Cabrera, MPH, Executive Director of CPCQC, SEN Steering Committee Member; and Jade Woodard, Executive Director of Illuminate Colorado and Co-Chair the SEN Steering Committee. 

The day also included two keynote addresses, first from Dr. Susanne Klawetter, Assistant Professor of Social Work, Portland State University, who highlighted the importance of using trauma-informed approaches given the prevalence of childhood trauma among mothers with a substance use disorder.    

After several presentations from hospitals participating in CHoSEN QIC and a discussion of barriers and facilitators to CHoSEN QIC implementation, clinicians received the final keynote address of the day from Dr. Ryan Jackman, St. Mary's Medical Center Faculty, Family Medicine Residency Medical Director, Integrated Addiction Medicine on treatment and recovery continuum on the West Slope. 

The next CHoSEN Forum is scheduled for May 12th in the Denver metro area.  ​