A Quality Improvement Initiative to Increase Scoring Consistency and Accuracy of the Finnegan Tool: Challenges in Obtaining Reliable Assessments of Drug Withdrawal in Neonatal Abstinence Syndrome.
A Quality Improvement Initiative to Increase Scoring Consistency and Accuracy of the Finnegan Tool: Challenges in Obtaining Reliable Assessments of Drug Withdrawal in Neonatal Abstinence Syndrome.
复制标题
旨在提高芬尼根工具评分一致性和准确性的质量改进举措：获得新生儿戒断综合症药物戒断可靠评估的挑战。
DOI：
10.1097/anc.0000000000000441
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Bloch-Salisbury,Elisabeth
中科院分区：
文献类型：
--
作者：
Timpson,Wendy;Killoran,Cheryl;Maranda,Louise;Picarillo,Alan;Bloch-Salisbury,Elisabeth
背景：目前诊断新生儿戒断综合征和指导新生儿药物戒断的药理学管理的实践依赖于护理评估和临床体征的反复评估。目的：这项单中心质量改进计划旨在提高新生儿护士Finnegan评分的准确性和一致性。方法：170名新生儿护士参加了一项纳入教育、评分指南和重组Finnegan量表的单期退出评估计划。护士对训练前后出现阿片类药物戒断症状的婴儿进行标准化录像评分。结果：培训后达到目标（Finnegan评分为8分）的护士比例（34.7%，平均误差= 0.559，SD= 1.4）是培训前（18.8%，平均误差= 1.31，SD= 1.95）的近两倍；001)。Finnegan评分显著高于训练前（mean= 9.31， SD= 1.95）和训练后(mean= 8.56， SD= 1.40, Wilcoxon P<。001);随访评估恢复到训练前水平（mean= 9.16， SD= 1.8）。与训练后（方差1.96）相比，训练前（方差3.80）得分分散性更大，肯德尔系数P<。001)主要是由于中枢神经系统症状的评分差异。对实践的启示：教育、临床指南和重组的评分工具增加了新生儿护士对婴儿戒断评估的一致性和准确性。然而，超过60%的护士在培训结束后没有立即评估退出目标分数，并且改善没有持续一段时间。研究意义：本研究强调需要更客观的工具来量化戒断严重程度，因为评估是新生儿戒断药物管理的主要驱动因素。
Background:Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs.Purpose:This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses.Methods:One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale. Nurses scored a standardized video-recorded infant presenting with opioid withdrawal before and after training.Results:Nearly twice as many nurses scored at target (Finnegan score of 8) posttraining (34.7%; mean error= 0.559, SD= 1.4) compared with pretraining (18.8%; mean error= 1.31, SD= 1.95; Wilcoxon, P<. 001). Finnegan scores were significantly higher than the target score pretraining (mean= 9.31, SD= 1.95) compared with posttraining (mean= 8.56, SD= 1.40, Wilcoxon P<. 001); follow-up assessments reverted to pretraining levels (mean= 9.16, SD= 1.8). Score dispersion was greater pretraining (variance 3.80) compared with posttraining (variance 1.96; Kendall's Coefficient, P<. 001) largely due to score disparity among central nervous system symptomology.Implications for Practice:Education, clinical guidelines, and a restructured scoring tool increased consistency and accuracy of infant withdrawal-assessments among neonatal nurses. However, more than 60% of nurses did not assess withdrawal to the target score immediately following the training period and improvements did not persist over time.Implications for Research:This study highlights the need for more objective tools to quantify withdrawal severity given that assessments are the primary driver of pharmacological management in neonatal drug withdrawal.