WAPC Infant and Family Committee Minutes May 10, 2013, 10:00 a.m. 2:30 p.m. WAPC Office, Madison, WI

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1 WAPC Infant and Family Committee Minutes May 10, 2013, 10:00 a.m. 2:30 p.m. WAPC Office, Madison, WI Participants: Mary Jo Snorek, Chair, Sarah Antczak, RN; Children s Hospital of Wisconsin, Milwaukee Betty Minton, RNC, BSN; St. Joseph s, Marshfield Jean Nowak, RNC, BA; Mayo Clinic Health System-Franciscan Healthcare, La Crosse Jill Paradowski, RN, MS; Medical College of Wisconsin, Milwaukee Janet Simdon, RNC; Fort Health Care, Fort Atkinson Lynn Sturm, RN, BSN; Gundersen Medical Center, La Crosse Sarah Walder, RNC, MSN, NNP-BC; Aspirus Wausau Hospital, Wausau WAPC/Perinatal Foundation Staff: Kyle Mounts Agenda Item Discussion Action/Plan Call to order M. Snorek called the meeting to order at 10:11 a.m. Welcome and introductions Participants did self-introductions. Approval of minutes from November 9, 2012 Motion made, seconded, and passed to approve the minutes as written. Announcements J. Paradowski reported that she attended an Umbrella Committee meeting for newborn screening. A pediatrician added an item to the meeting agenda regarding neonatal abstinence screening. The pediatrician cared for an infant experiencing withdrawal in the NICU. The physician followed the protocol for newborn screening in the NICU and the infant had additional screens. One of the screens had a false positive result. The parents of the infant expressed concern over the test result. The physician was interested in knowing about opt out options for newborn screening in this circumstance. J. Paradowski reported that the newborn screening process has developed to ensure that infants with positive screens have appropriate follow up. NICU screening occurs more frequently because of hypothyroidism. J. Paradowski expressed concern about opening the consent process to exceptions, as the process has developed to minimize the risk of missed screens. She encouraged the committee to contact newborn screening 1

2 Volunteer time Annual conference Pregnant women in opioid treatment and their infants if there were questions or concerns about the process. If things affect the unit, contact newborn screening. S. Antczak 2.5 hours M. Snorek 2 hours B. Minton 1 hour L. Sturm 1 hour J. Simdon 1 hour S. Walder 2.5 hours Review of 2013 topics. K. Mounts reviewed the topics and speakers for the 2013 Annual Conference. Suggestions for topics and speakers for 2014 Annual Conference: ethics outcomes for neonatal hypothermia for HIE update on ACA (perhaps as a plenary) newborn screening (update; basics cost, requirements, guidelines) electronic charting how has it affected personal care navigation chronic diseases (nurse navigator) the navigator facilitates discharge planning and care at home (Prohealth has a program) simulation with NRP protocols repercussions of parents declining foreign substances in their baby (e.g., antibiotics for rule out sepsis, erythromycin) Birth to 3 programs lack of services, difficulties with accessing services (lack of reimbursement for clinics in hospitals because Birth to 3 is available), role of CYSHCN and Family Resource Centers safe sleep how to be facilitators in the hospital for moms, models that work Sheboygan meeting. K. Mounts reported that Sheboygan County Public Health will host a meeting, Starting the Conversation: Forum on Women and Infants Affected by Opioids, on May 16, Sheboygan County identified neonatal withdrawal as an emerging issue. Representatives from public health contacted WAPC about the issue. WAPC worked with Sheboygan County public health to develop a program agenda. WAPC arranged for speakers, facilitated presentation development, ensured availability of continuing education credit, and provided support at the meeting. NAS scoring Webinar. K. Mounts announced that WAPC will host a Webinar, Assessment of Neonatal Abstinence Syndrome: Tools for K. Mounts will add topics to list for Annual Conference Planning Committee 2

3 Newborn Nursery Staff, on July 24, Pediatric Progress conference. K. Mounts reported that the Wheaton Franciscan Healthcare-St. Joseph Pediatric Progress conference scheduled for May 22, 2013, focuses on neonatal withdrawal. WINpqc project. S. Walder reported that WINpqc will focus on neonatal abstinence. A recent meeting was held in Nashville, TN, that included representatives from 11 state perinatal quality collaborative groups. Wisconsin has the longest length of stay among the states represented, in part because many states discharge infants to medical foster homes. The goal of the quality collaboratives is to reduce length of stay by developing and using standardized protocols. WINpqc includes hospitals with NICUs. The Tennessee (TIPqc) and North Carolina (PQCNC) quality collaboratives are especially strong in the area of neonatal withdrawal. K. Mounts asked that WINpqc representatives involve WAPC to facilitate implementation in hospitals not part of the quality collaborative. Newborn Withdrawal toolkit. K. Mounts reported that the revised toolkit is available on line. An attendee at the 2013 Annual Conference suggested changing the name of the materials to eliminate the word project. She said that one family she worked with asked if it was part of a research project. Committee members agreed that eliminating the word project may be more family friendly. The current materials are specifically focused on opioid withdrawal. Committee members suggested developing additional pieces, addressing nicotine, SSRIs, alcohol, and marijuana that could be used in prenatal classes and for families after the baby is born. Patient FAQs. The committee discussed FAQs for women on opioids. The committee suggested the following questions: How long does withdrawal take? What things do you look for with NAS scoring? (J. Simdon) Are there legal ramifications? How long do I have to take the medication to show signs of withdrawal? Can I breastfeed? (L. Sturm) Should I breastfeed? (L. Sturm) Do I have to be hospitalized for withdrawal? What can I do to help my baby? (J. Paradowski) K. Mounts will discuss toolkit name change with other WAPC/PF staff. K. Mounts will discuss developing other pieces for neonatal withdrawal with other staff members. K. Mounts will edit questions and send them to committee members to develop answers. 3

4 Caring for the late preterm infant How much do I take each day to show signs of withdrawal? How long will baby be in hospital? What are the long-term problems? Will it affect my baby s brain? Will my baby go home with me? Why can t we do this at home? Committee members volunteered to develop answers for some of the questions. Volunteers are indicated by parentheses in the list. Hospital practices. Elizabeth Goetz, MD, MPH, IBCLC, asked what other hospitals are doing with asymptomatic infants who require observation beyond the typical hour stay. Meriter currently uses the NICU for observation. M. Snorek reported that at Aurora Healthcare Grafton infants are observed for 5 days. The infant s mother is discharged according to her condition. They try to room mom and baby together in postpartum, but if postpartum is busy, there are two rooming in rooms available. J. Simdon reported that Fort Atkinson s routine is similar discharge mom and keep mom and baby together. M. Snorek reported that St. Mary s in Madison sends the infants to the pediatric unit. S. Walder reported that Wausau does not keep them for 5 days. They discharge them and ensure close follow-up with pediatricians. She added that several mothers have brought babies back to the hospital because of difficulties with withdrawal. Other possible Webinar topics. The committee discussed other potential Webinars. A DVD is available that addresses scoring neonatal abstinence using the Finnegan tool. The committee suggested: Tanya Hiser s (the State Opioid Treatment Authority) presentation from the Annual Conference on methadone treatment, collaborative models between hospitals and opioid treatment centers, education and suggestions for providers on tips to help parents care for their infants at home, nursing measures for the care of infants in the hospital. Materials on Web site. K. Mounts reported that the Caring for the Late Preterm Infant orders and care plan are on the WAPC Web site. Preemies Hidden from Plain View self-study module. The committee reviewed the 2009 version of the module and made changes on the PowerPoint presentation. The committee discussed the potential K. Mounts will give information to Elizabeth Goetz. May 28, 2013 Addendum: Elizabeth Goetz acknowledged receipt of the information and thanked K. Mounts for sending it. K. Mounts will discuss other Webinar topics with WAPC/PF staff K. Mounts will make the suggested revisions to the Preemies presentation and send the revised presentations to the committee for review. 4

5 Safe sleep Guidelines for the Responsible Utilization of Neonatal Intensive Care Next meeting need for two modules, one for feeding issues and the other for all other aspects. In addition, the committee suggested expanding the sections related to discharge to cover more information related to planning and family needs. The committee recommended reviewing the Caring for the Late Preterm Infant orders and care plan and the PowerPoint presentations from the Caring for the Late Preterm Infant: What We Need to Know and Coming to Term: Promoting Delivery after 39 Weeks Regional Forums to ensure consistency of messages. FAQs. J. Paradowski recommended checking national organizations/groups to evaluate what FAQs are already available. Organizations/groups include Project Impact, CityMatch, NICHD, and First Candle. Other ideas. The committee discussed other potential needs for safe sleep environment information infant death reviews in other counties (Milwaukee and Dane counties have FIMR teams); education for law enforcement officers (e.g., what does a safe sleep environment look like?); media portrayals from parents perspectives; marketing does it encourage safe sleep? K. Mounts reported that the position statement, Guidelines for the Responsible Utilization of Neonatal Intensive Care, is scheduled for review and revision between July and December The initial reviewers will be primarily content experts. The second group of reviewers will include both content experts and intended audience members. K. Mounts will check the sources suggested and will contact Jason Jarzembowski, MD, PhD, and Jill Radowicz, RN, for additional information/resources. K. Mounts will update the committee on progress of the position statement. August 23, 2013, 10:00-2:30 p.m. at WAPC office. Adjournment M. Snorek adjourned the meeting at 2:30 p.m. and thanked all for attending. Respectfully submitted by: Kyle Mounts WAPC/PF Learning Coordinator G:\Infant & Family Ctm\Minutes\2013\May 10 FINAL.docx 5