Initiative
Neonatal Opioid Withdrawal Syndrome (NOWS)
Formerly known as Neonatal Abstinence Syndrome (NAS), NOWS refers to the collection of signs and symptoms that may occur in opioid-exposed newborns shortly after birth. Between 2010 and 2013, the number of infants with NOWS doubled with a total cost exceeding $23 million in Alabama. The ALPQC aims to reduce variation in treatment and optimize the care of infants with NOWS with goals of optimizing nonpharmacologic management, pharmacologic management, and provideing a safe discharge for infants and mothers.
Project Aim
Our global aim is to optimize inpatient care strategies for infants born with neonatal opioid withdrawal syndrome. Specifically, among infants born with NOWS at > 35 weeks GA in participating hospitals, by April 2022 we aim to:
Reduce length of stay by 20%
Reduce exposure to pharm care by 20%
Increase the percentage of infants discharged with a coordinated care plan to 95%
Key Documents
- NOWS Charter (June 2022)
- NOWS Getting Started Kit (June 2022)
- NOWS Toolkit & Checklist
- NOWS Driver Diagram
- NOWS Team Roster
REDCap Data Portal Submission Schedule
| Monthly Data Measures* | Due Date | Quarterly Data Measures | Due Date |
| September 2022 | November 30, 2022 | July – September 2022 | November 30, 2022 |
| October 2022 | November 30, 2022 | ||
| November 2022 | December 31, 2022 | ||
| December 2022 | January 31, 2023 | October – December 2022 | January 31, 2023 |
| January 2023 | February 28, 2023 | ||
| February 2023 | March 31, 2023 | ||
| March 2023 | April 30, 2023 | January – March 2023 | April 30, 2023 |
| April 2023 | May 31, 2023 | ||
| May 2023 | June 30, 2023 | ||
| June 2023 | July 31, 2023 | April – June 2023 | July 31, 2023 |
| July 2023 | August 31, 2023 | ||
| August 2023 | September 30, 2023 | ||
| September 2023 | October 31, 2023 | July – September 2023 | October 31, 2023 |
| October 2023 | November 30, 2023 | ||
| November 2023 | December 31, 2023 | ||
| December 2023 | January 31, 2024 | October – December 2023 | January 31, 2024 |
*Links for monthly data collection will be shared with data entry designees on the first of each month.
Toolkit
Care Team Education
Increase Use of Patient-Centered Language
- Beyond Labels: Do Your Part to Reduce Stigma
- Disrupting Stigma: How understanding, empathy, and connection can improve outcomes for families affected by substance use and mental disorders (NEW)
- Say This Not That – Language Matters
- Stop Judging, Start Healing Campaign (ADPH, ADMH)
- SAMHSA Words Matter: How Language Choice Can Reduce Stigma
- OPQC Substance Abuse 101: MythBusters
- Reducing Stigma Education Tools (ReSET) Modules – PCSS
- Stigma and Opioid Use Disorder Webinar: What Pediatricians Need to know in Caring for Mothers and Children (AAP)
General Resources
- Maternal-Infant Health and Opioid Use: Education and Professional Development (AAP)
- Recovery-Friendly Family-centered Pediatrics (AAP)
- PCSS Resources for Health Professionals, Patients and Community
- IHI Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care
- SAMHSA: Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants
- Provider Education Resources, FPQC
- Partner with Mothers to Seek and Support Recovery Post Prenatal Opioid Exposure
- National Clinician Consultation Center: Substance Use Management
- Peer Support in the Neonatal OB Department
Naloxone
Safe Sleep
Withdrawal Scoring Consistency
Screening Tool Videos:
Non-Pharmacologic Care & Keeping Mother-Baby Dyad Together
- ALPQC NOWS Toolkit Nonpharmacologic Management
- Non-Pharmacologic Care Definition
- How to Care for a Baby with NAS Infographics
- Eat, Sleep, Console: a family-centered approach to manage NAS (OPQIC)
- Eat Sleep Console Simulation & Debrief Video (ILPQC)
- Engaging Mom in Nonpharmacologic Care Simulation & Debrief Video (ILPQC)
- Sample Rooming-In policy for mother-infant dyad impacted by in-utero opiod exposure (Baystate Children’s Hospital, IL)
Improve Infant Nutrition and Breastfeeding
- Support Breastfeeding Flyer
- ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder
- Breastfeedign Myth vs Fact – NICHQ (NEW)
Pharmacologic Care Consistency
Collaborative Discharge Plan & Patient Education
- ALPQC NOWS Toolkit: Creating a Collaborative Discharge Plan
- NOWS: Planning the Mother-Infant Dyad Discharge (AAP)
Collaborative Discharge Tools
- ALPQC NOWS Discharge Checklist
- ALPQC NOWS Resources in Our Service Area
- ALPQC NOWS Collaborative Discharge Plan (Updated July 2022)
- ALPQC Perinatal Resource Directory
Peer Support
- Peer Support Services for Pregnant and Postpartum Patients
- Peer Support in the Neonatal OB Department
- Alabama Warm Line for Mental Health
- People Engaged in Recovery (PEIR)
Naloxone education
- Naloxone Patient Education Brochure
- Opioid Safety and How to Use Naloxone
- Naloxone Training and Kits
Family Education
- NOWS: What You Need to Know – A Guide for Families
- Be with your baby: You are the treatment!
- ESC – Caring for Your Baby with Love
- MORE Hope: Helping our Parents Excel
- Pregnancy: Methadone and Buprenorphine
- Better Together to Prevent Neonatal Opioid Withdrawal Syndrome
- NAS Brochure
Safe Sleep (NEW)
- Safe Sleep for Infants – Myth vs Facts (NICHQ)
- Safe Sleep for Your Baby – Materials for Caregivers and Families (NICHD)
- Safe Infant Sleep and Breastfeeding Videos (NICHD)
Other resources:
- Virtual Recovery Resources – SAMHSA (NEW)
- Medication-Assisted Treatment – SAMHSA
- Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants – SAMHSA
- ACOG District II OUD in Pregnancy Resource
- Obstetric Care for Women with Opioid Use Disorder, AIM Bundle
- Prenatal Consultation Guidelines, ILPQC
- NNEPQIN: Federal Legislation Regarding Infant Plan of Safe Care
Additional Resources
- ALPQC NOWS Toolkit Additional Resources
- Illinois Perinatal Quality Collaborative – Mothers and Newborns Affected by Opioids (MNO), Neonatal Initiative
- Florida Perinatal Quality Collaborative – NAS Initiative
- Ohio Perinatal Quality Collaborative – NAS Project
- Northern New England Perinatal Quality Improvement Network – Toolkit for the Care of Substance Exposed Newborns
- AAP Clinical Report: Neonatal Opioid Withdrawal Syndrome
- AAP Policy Statement: A Public Health Response to Opioid Use in Pregnancy
- AAP Clinical Report: Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening
- ILPQC MNO Prenatal Consultation Guidelines
Action Period Calls & Webinars
2022
- October 2022 Action Period Call: Reviewing Baseline Data & Benchmarks | Slides
- September 2022 Action Period Call: Do Less Harm | Slides | Recording
- August 2022 Action Period Call: NOWS Call to Action | Slides
- July 2022 Learning Session 1.2 : QI and Data | Slides | Recording
- July 2022 Learning Session 1: NOWS Overview | Slides | Recordings:
Archive
- Withdrawal Scoring – July 2021
- Non-Pharmalogic Management – June 2021
- Baseline Data & Infant Discharge – May 2021
- Supportive Maternal Discharge – April 2021
- Baseline Data Collection Review & PDSA Cycles – March 2021
- Collecting and Entering Data – February 2021
- Learning Session 1 – January 2021
- ALPQC 2020 Summit