View
223
Download
0
Category
Preview:
Citation preview
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
1/19
Copyright 2014 Wright and Retskin NAS
Inter-Observer Reliability ofthe Modified Finnegan Score
in a Population of Neonatal
and Pediatric Nurses
Cathy Retskin, MSN, RNC
DNP Candidate Walden University
Mary Ellen Wright, MSN, APRN, CPNP
PhD Candidate Florida Atlantic University!"#$%&'() +,-. /0)12&3 435 6%&'()
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
2/19
Copyright 2014 Wright and Retskin NAS
History of Mission Hospital Neonatal Abstinence Syndrome/Neonatal Withdrawal Initiatives
,
+,
.,
7,
8,
-,,
-+,
+,-, +,-- +,-+ +,-9:
!"#$%& () *+$,%- .&%+/%0 1%& 2%+& +/
3,--,(4 5(-1,/+6
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
3/19
Copyright 2014 Wright and Retskin NAS
Timeline of Mission Health NAS InitiativeYears of Effort
Aim: To provide consistent, comprehensive, caring approaches
to infants and families affected by NAS
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
4/19
Copyright 2014 Wright and Retskin NAS
;< =>>?
;@? A3&B4BC0 7(##"4,/87(66+$(&+9:%
;41+9%4/ !(##,?%%
D(4%F4!"G"'&!
H434'0F03)
I04F
;"3J
D(4%F4!"G"'&!
H434'0F03)
I04F
;@? ?)00%&3'
(##,?%%
L4F&G$
DG433&3'
I(%"M'(
H@>N
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
5/19
Copyright 2014 Wright and Retskin NAS
Opportunities to Standardize Care Processes
Murphy-Oikonen, Motelpare, Bertoldo, Southon & Persichino, 2010. Retrospective cohort comparison pre and post implementation of
clinical practice guideline.
Conclusion: Decrease in Finnegan ScoresDecrease in Length of Stay
Identification
Evaluation
Treatment
Discharge
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
6/19
Copyright 2014 Wright and Retskin NAS
Mission Process Mapping
Just One Example
Details not visible: Point just to show broad view of mapping
"#$%&' (&)*$+,&
-./0$*12& 30& 45
!"#$% "'( )*+,-*%.
(# 6'&1*$*7 8*'&967*2&1$* :/'.;$+#19 45
+#7&12&9 45 #?
-./0$*12& 30& @+$%+1 A B'0"*$&'1*7
C#5+2#7#)B
-2'&&1+1) (&)*$+,&6#0+$+,&
/$01*% 2"#. 3',0
/$01*% 2"#. 3',0
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
7/19
Copyright 2014 Wright and Retskin NAS
All Areas had Opportunities for Improvement
Formed Sub-Committees to address the opportunities in the areas of
identification, evaluation, treatment and discharge.
Steering committee coordinates the overall initiative with reports from
the sub-committees.
Example of initiative derived from looking at evaluation:
Inter-Observer Reliability (IOR) of the Modified Finnegan of Nurses
from Mother/Baby, Pediatrics, PICU, NICU and nurses in the region.
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
8/19
Copyright 2014 Wright and Retskin NAS
EvaluationInter-Observer Reliability of Modified Finnegan Score
Origin of study: Comments being made at provider meetings
Depends on what shift of nurses and who is doing the
Finnegan. . .
Impression that there was variability without evidence.
The purposeof the study was to determine if there is inter-
observer reliability (IOR) of the Finnegan Neonatal Abstinence
Scoring Tool (FNAST) among nurses caring for infants withneonatal abstinence syndrome (NAS) in the NICU, Mother/Baby
and PEDS/PICU units and regional nurses.
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
9/19
Copyright 2014 Wright and Retskin NAS
Description of Nurses in Study
Education Level, Years Experience, Certification
Total n=122
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
10/19
Copyright 2014 Wright and Retskin NAS
Methods
An interactive DVD developed
by Karen DApolito, PhD, APRN,
NNP-BC and Loretta Finnegan, MD
on the IOR of the FNAST was
used with permission.
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
11/19
Copyright 2014 Wright and Retskin NAS
Methods
IRB approval, Mission Research Institute and Nursing ResearchCouncil Approval obtained.
Potential participants for this reliability study would come fromnursing staff in the NICU, Mother/Baby, and PEDS/PICU units andnurses in the region.
Participation in the study was conducted through annual education,staff meetings, Care Partners and regional member hospitals.
Consent to participate was obtained. Vignette was shown, and the nurses were asked to score using the
Modified Finnegan Scoring System for Neonatal Abstinence
Syndrome Comparison was made to the expert score and Inter-Class
Correlation for IOR was calculated using SPSS.
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
12/19
Copyright 2014 Wright and Retskin NAS
Results
A3)0%J!G411
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
13/19
Copyright 2014 Wright and Retskin NAS
IOR in Sections of the FNAST
The least inter-observer reliability was in the area of the Central
Nervous System with ICC at 0.603.
Question: Is that consistent in different tests of IOR? We may want asa collaborative to compare those findings.
A!9(4 ;4/&+>6+--7(&&%6+9(4
7(%B>,%4/
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
14/19
Copyright 2014 Wright and Retskin NAS
Discussion
Study offered opportunity for education.
Modified Finnegan Scoring was added to orientation, continuing
education for existing nurses.
Medical Resident education on Modified Finnegan scoring.
Sharing with providers the results and standardization.
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
15/19
Copyright 2014 Wright and Retskin NAS
Standardizing the Environment of Finnegan ScoringWork currently underway
Score in standard environment
!Quiet
!Minimize noxious lights
!After feeding
!In mothers arms?
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
16/19
Copyright 2014 Wright and Retskin NAS
Education to Move to Standardization of Creating theEnvironment for Modified Finnegan
Adding the standardization of creating the environment for scoringthrough:
Nursing Education
OrientationResident Education
Physician Service Line Provider Meetings
Quality Rounds
Huddles
Newsletters
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
17/19
Copyright 2014 Wright and Retskin NAS
Informing Standardization through Work of Sub-Committees
;0%49C>+9(4
="$>(##,?%%
;7DEF >(0%-
=>&%%4,4G
.(H,>(6(G8
.&%+/#%4/ I
@J++>(6(G,> -"$E
7(##,?%%
!(4E@J++>(6(G,>
="$ I 7(##,?%%
K:+6"+9(4
7&%+94G K4:,&(4#%4/
)(& 3E A,44%G+4L
7(#16%/%0 ;MN () 3E
A,44%G+4
D,->J+&G%
="$>(##,?%%
D,->J+&G% >&,/%&,+
=/+40+&0,O% %0">+9(4
7(##"4,/8 A(66(PE"1
D"G&!$ 435 D%"!05M%01
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
18/19
Copyright 2014 Wright and Retskin NAS
The nice thing about teamwork is that you alwayshave others on your side
Margaret Carty
8/13/2019 Inter-Observer Reliability of the Modified Finnegan Score in a Population of Neonatal and Pediatric Nurses
19/19
Copyright 2014 Wright and Retskin NAS
References
D'Apolito K; MCN: The American Journal of Maternal Child Nursing, 1999 May-Jun; 24 (3): 138-44.DApolito, K. & Finnegan, L. (2010). Assessing signs & symptoms of neonatal abstinence syndrome
using the Finnegan Scoring tool: An inter-observer reliability program [DVD]. Nashville, TN:NeoAdvances, LLC.
Finnegan, L., Connaughton, J., Kron, R. & Emich, J. (1975). Neonatal abstinence syndrome:Assessment and management.Addictive Diseases: An International Journal. 2(1), 677-687.
Franck, L.S., Harris, S.K., Soetenga, D.J., Amling, J.K., Curley M.A. The withdrawal assessment tool 1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal
symptoms in pediatric patients. (2008). Pediatric Critical Care Medicine. 9(6), 573-580.Murphy-Oikonen, J., Montelpare, W.J., Bertoldo, L., Southon, S.,
Persichino, N. (2012). The impact of clinical practice guideline on
infants with neonatal abstinence syndrome. British Journal of Midwifery, 20(7),
493- 501
Retskin, C.M. & Wright, M.E. (2013). Inter-Observer Reliability of the Modoified Finnegan Neonatal
Abstinence Scoring Tool in an Acute Care Setting. Poster presentation at the 2013 VermontOxford Network Annual Meeting. Manuscript submission
Zimmermann-Baer U, Ntzli U, Rentsch K, Bucher HU. (2010). Finnegan
neonatal abstinence scoring system: normal values for first 3 days and weeks 5-6 in
non-addicted infants. Addiction. 2010 Mar;105(3):524-8.
Recommended