What is the PICOT question?

Among infants diagnosed with Neonatal Abstinence Syndrome (NAS), does the use of supportive, nonpharmacological care decrease their length of stay when compared to the pharmacological use of methadone & morphine?

Define each element of the question below:

P– (Patient, population, or problem): Infants born diagnosed with NAS (withdrawing)

I– (Intervention): use of nonpharmacological, supportive measures (swaddling, skin-to-skin, cuddling, donor breast milk, aromatherapy, weighted blankets, vibrotactile stimulation crib mattress, rocking, etc.)

C– (Comparison with other treatment/current practice): pharmacological use of methadone & morphine

O– (Desired outcome): decreased length of stay by any amount of time

T-(Time Frame):n/a

Neonatal Abstinence Syndrome (NAS) is a group of conditions caused when babies are exposed to certain drugs such as opiates, heroin, benzodiazepines, antidepressants, or methadone/suboxone/Subutex in utero prior to birth that leads the infant to withdraw after birth. The prevalence & incidence of NAS continue to increase as the levels of opiate & IV drug use continue to significantly increase each day in the U.S. Some sources say that every hour an infant is born with NAS in the United States. NAS has many symptoms & complications for babies including body shakes, seizures, overactive reflexes, hypertonia, excessive crying, high-pitched cries, poor feeding, breathing problems, weight loss, fever, sweatiness, stuffy nose, sneezing, diarrhea, throwing up, trouble sleeping, jaundice, & low birth weight, or preterm delivery. Typically, these infants are scored using Finnegan’s Scoring Tool & too often, are being prescribed methadone & morphine for their withdrawal symptoms. To deal with this more effectively & provide patients with the best quality care possible, Neonatal Intensive Care Units (ICUs) should be doing everything possible to alleviate these symptoms without the unnecessary implementation & exposure to more drugs like methadone & morphine. The education of staff & parents is a much-needed implementation along with the use of nonpharmacological, supportive measures.

What is the practice area?

(Check all that apply.)                                                               Administration

✓  Clinical                                                                                   Other

✓  Education

all that apply)                                                                          Difference between hospital & community practice

✓  Safety/risk management concerns                                Clinical practice issue is a concern

✓Unsatisfactory patient outcomes (lengthy Procedures or processes is a waste of hospital stays)                                                                         Clinical practice issue has no scientific base

✓  Wide variations in practice                                              Other:

✓  Significant financial concerns (many are on Medicaid)

I would search the following six areas to find evidence relating to recent research & best practices regarding lengthy hospital stays and neonatal Abstinence Syndrome (NAS) in NICU-admitted infants using the following search terms listed below. I would investigate the recent guidelines for the use of nonpharmacological, supportive measures like swaddling, skin-to-skin, cuddling, donor breast milk, aromatherapy, weighted blankets, vibrotactile stimulation crib mattress, rocking, etc. I would check to see what other local facilities (REX, WakeMed, Duke University) are using for NAS infants. Has a study been done using this theory before? Have infants had better NAS scores with the use of nonpharmacological, supportive measures? Are there any national/state/medical regulatory standards on using these therapies or using methadone & morphine? I would also see what the cost per day NICU stay is with & without the use of methadone & morphine measures, as nonpharmacological, supportive measures would be at no additional charge. Is there an expert opinion regarding the use of both pharmacological & nonpharmacological measures? Which is preferred? Why?

✓  Literature search                                                         Clinical Expertise

✓  Guidelines                                                             ✓ Financial Analysis

✓  Expert Opinion                                                     ✓ Standards (Regulatory, professional, community)

✓  Patient Preferences                                                    Other

Search terms/How to narrow the search?

Neonatal Abstinence Syndrome, NAS, withdrawal, infants, therapy, pharmacological, nonpharmacological, high-quality care, NICU, lengthy hospital stays, financial aspects, cost, patient safety, methadone, morphine, nursing education, neonatal nursing, swaddling, rocking, weighted blankets, aromatherapy, skin-to-skin

I would use multiple different search databases, including PubMed & CINHAL, maintain a list of search terms (used & unused), limit the search within the last five years, limit the search to peer-reviewed articles & scholarly sources, use the OR search to keep terms & phrases together, & limiting the search to full text (html or pdf).