Success Story: Improving the care of neonates exposed in utero to opiates

Rooming-in is the standard of care for healthy babies born at Victoria General Hospital, meaning that they stay in the same room as their mother for the duration of their hospital stay. Babies born to mothers with opioid use disorder should have the same care. However, in a significant portion of cases, those babies end up being transferred to the Neonatal Intensive Care Unit (NICU) if they develop significant symptoms of withdrawal (called Neonatal Abstinence Syndrome), and therefore are separated from their mothers, sometimes for weeks until hospital discharge.

Studies have shown that ‘rooming-in’ for infants exposed to opioids during pregnancy has many significant positive advantages. It results in reduced need for pharmacotherapy, shorter hospital stays, higher rates of breastfeeding initiation, and decreased admissions to the NICU. Yet accommodating the needs of these infants in the same location as their mothers requires complex coordination between all members of the care team and support community. Victoria Pediatricians Drs. Marie-Noelle Trottier Boucher, Katrina Stockley and Lauren Kitney wanted to build consensus for a rooming-in model to support mothers with opioid disorders in Victoria. Drawing on funding from both the South Island Medical Staff Association and the Physician Quality Improvement fund, they engaged key stakeholders and care providers in a multi-stage approach to improving care with this population.

They first organized a multidisciplinary meeting with physicians, nurses, social workers, Aboriginal liaison, and other allied health personnel, as well as Island Health administrators, community organizations, Ministry of Children and Family Development staff, and parent representatives to review current inpatient care practices at Victoria General Hospital. Thirty-five people participated and provided insights into barriers and facilitators for rooming-in. These insights were summarized and displayed in a graphic representation that was posted in multiple locations (Labor and Delivery Unit, Neonatal Intensive Care Unit and Mother and Baby Unit) to continue the process of eliciting feedback. A smaller group meeting followed a month later to review findings and determine how best to facilitate rooming-in. Earlier this year, the team drew on the insights from these previous meetings to design a draft pathway enabling mother and baby to stay together regardless of the need for NICU treatment. After this pathway receives input and support from Island Health administration and is reviewed and approved by each department, it will be finalized and implemented.

The funding received from the South Island Medical Staff Association added value as it allowed patient’s voices to be heard. Parents who experienced the specific challenges of the limited rooming-in possibilities once their babies developed symptoms of withdrawal in our institution were able to contribute to all steps of our project. Dr. Trottier-Boucher noted that their participation in this project was invaluable, as it helped the group to have a better understanding the unique challenges these mothers face, to see things from a different perspective and to contribute different ideas for improvement.

The next steps for this work include engaging with Island Health to finalize the pathway and to work on the introduction of a new model of evaluation and care for these infants exposed to opioids during pregnancy called ‘Eat Sleep and Console’. Ongoing funding from both the South Island Medical Staff Association and Physician Quality Improvement Program will help this dynamic team to continue their project. We wish them all the best in their upcoming work and thank them for their hard work bringing this important work to light!

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