The Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC) and the Massachusetts Perinatal Quality Collaborative (MPQC) are excited to support a statewide quality improvement initiative focused on improving the care of infants and families impacted by perinatal opioid use and neonatal abstinence syndrome. Building upon years of past work by hospitals and organizations throughout the state, this initiative was formally launched in January 2017 and relies on close collaborations with many state partners, including the Department of Public Health, the Bureau of Substance Addiction Services, the Department of Children and Families, Early Intervention, and the Health Policy Commission.
All hospitals that care for mothers or newborns are invited to participate. Please see the drop down menu below to access more information on the various components of our project.
For more information, please contact:
Elisha Wachman, Neonatal Lead
Davida Schiff, Pediatric Lead
Emilia Mannstadt, Project Coordinator
POP Project Documents
The POP project documents are included below including: Early Intervention (EI) One-Pager and a selection of POP Project Webinars.
Early Intervention Project
One of the primary goals of the PNQIN statewide Perinatal Opioid Project (POP) is to improve the follow-up of infants at risk for neonatal abstinence syndrome (NAS) by increasing enrollment of these infants in Early Intervention (EI). State data shows us that referral is only one step in the process, and that even if most infants with NAS are referred to EI before discharge, rates of enrollment are significantly lower. To address this issue, PNQIN and the Massachusetts Department (MDPH) are leading a structured QI initiative to improve EI referral and enrollment rates among substance exposed newborns (SEN) and infants with NAS.
PNQIN Spring Summit 2019 Early Intervention Breakout Session
Early Intervention and NAS: What We Can Learn From Families and Hospitals:
Hafsatou Diop, MD, MPH; Elizabeth Peacock-Chambers, MD, MSc; Jennifer Lee, MD
In this breakout session, leaders defined a Family Centered Care (FCC), described the primary components of FCC for this population of pregnant, postpartum and parenting women with opioid use disorders, described ways in which peer mentors are powerfully influential in providing FCC, and described ways that organizations can support and develop the role of peer mentors in implementing FCC. To view the presentation, click here.
Postpartum Psychedelic Therapies and Intergenerational Trauma: The Investigational Use of MDMA for Opioid Use Disorder/PTSD and Psilocybin or Ketamine for Postpartum Depression.
Opportunities to ACT NOW for Infants with Neonatal Opioid Withdrawal: The Eat, Sleep, Console Clinical Trial
Whole Person Care for People with Substance Use, Newborns and Families: COMPASSION model
PNQIN POP Webinar: Sustaining Highly Trained and Compassionate Providers (4/26/24)
Statewide Data
The POP Project Team has made available two types of Data Reports. The first type are statewide Quarterly Data Reports which summarize performance for the PNQIN statewide initiative to improve the care of families impacted by perinatal opioid use and infants at risk for Neonatal Opioid Withdrawal Syndrome (NOWS). Secondly, the POP team will occasionally survey MA hospitals that care for birthing individuals and infants on their practices caring for families impacted by perinatal opioid use and infants at risk for Neonatal Opioid Withdrawal Syndrome (NOWS).
The Quarterly Data Reports will no longer be reported starting in June 2025. All prior data reports are available.
Monthly statewide key metric reports are below. This page contains only the statewide key metric report.
If you are looking for your hospital specific report, please email Emilia Mannstadt at emannstadt@pnqinma.org.
2024 Reports
- PNQIN Opioid-Exposed Newborns Statewide Progress Report – Quarter 2 2024
- PNQIN Opioid-Exposed Newborns Statewide Progress Report – Quarter 3 2024
2023 Reports
- PNQIN Opioid-Exposed Newborns Statewide Progress Report – Quarter 2 2023
- PNQIN Opioid-Exposed Newborns Statewide Progress Report – Quarter 3 2023
- PNQIN Opioid-Exposed Newborns Statewide Progress Report – Quarter 4 2023
2022 Reports
- PNQIN Opioid-Exposed Newborns Statewide Progress Report January 2022
- PNQIN Opioid-Exposed Newborns Statewide Progress Report February 2022
- PNQIN Opioid-Exposed Newborns Statewide Progress Report March 2022
- PNQIN Opioid-Exposed Newborns Statewide Progress Report June 2022
- PNQIN Opioid-Exposed Newborns Statewide Progress Report September 2022
Statewide Practice Surveys are distributed by the POP Leadership team to survey MA hospitals that care for birthing individuals and newborns about the clinical practices around perinatal opioid use and neonatal abstinence syndrome. The survey questions are designed to be answered by all types of care providers in both obstetrics and newborn care.
To learn more, please contact Emilia Mannstadt or Dr. Elisha Wachman.
Resources
A number of resources have been compiled for reference including trainings, state-level and national-level resources, and other relevant tools for improving the care of opioid exposed newborns and birthing individuals affected by opioid use disorder.
State Guidelines
Massachusetts Department of Public Health (DPH):
Massachusetts Department of Children and Families:
State Resources
Family Ties
Online Stigma, Bias, and Trauma-Informed Care Training
Description: In partnership with the Brigham & Women’s Hospital C.A.R.E. (Coordinated Approach to Resilience and Empowerment) Clinic, PNQIN is proud to offer online stigma, bias, and trauma-informed care training. This team-focused training is led by Dr. Annie Lewis-O’Connor and is intended for maternal and neonatal health care and service providers. The training content is centered on patients experiencing Substance or Opioid Use Disorder (SUD/OUD) and Neonatal Abstinence Syndrome (NAS).
Training topics include: Trauma, Adverse Childhood Experiences (ACEs), unconscious bias and stigma, structural racism, and the six principles of trauma-informed care.
Training objectives:
Understand the roles of stigma, bias, and trauma-informed care and resilience on disparities in health and birth outcomes specifically:
Pain management for pregnant and postpartum patients experiencing OUD
Discharge and prescription practices for obstetric patients
OUD treatment bias for pre- and postpartum patients
IMPORTANT: This training was initially designed to be interactive and delivered in a group setting. We encourage you to gather a group from your hospital to watch the training recording, then debrief and discuss together. All team members must register individually and complete the post-test survey individually. Please do so, as this will help us keep accurate records of who completed the training. Thank you!
To register for this training as a Nursing CEU credit-seeker, please click here.
To register for this training as a CME or Social Work credit-seeker, please click here.
Additional TIC Resources:
National Birth Equity Collaborative
NNPQC Thematic Webinar on Trauma-Informed Care: Addressing Stigma and Bias
The Eat, Sleep, Console NAS Care Tool
The most commonly used NAS assessment tool in the U.S., often modified by individual institutions, is called the Neonatal Abstinence Syndrome Score (NASS). This tool, more commonly referred to as the Finnegan Scale, was developed in 1974. It contains a list of the most common neonatal opioid withdrawal signs with points assigned for each item based on its perceived severity. Pharmacologic treatment is titrated based on the total NASS score. Recent quality improvement (QI) initiatives have developed a new approach to guide medication treatment, focusing on the infant’s functioning; specifically, how well the infant is eating, sleeping, and how consolable the infant is. This approach, called the “Eat, Sleep, Console” (ESC) approach, is just one component of a comprehensive family-centered non-pharmacologic care approach, and has resulted in less medication treatment in the context of QI projects. While we believe the infant should continue to be assessed for signs of opioid withdrawal with a tailored treatment approach, the ESC method’s sole principle is that the pharmacologic treatment of the infant should be primarily based on infant function and comfort, as opposed to reducing all signs of opioid withdrawal. This method of assessing infants with NAS was developed by a collaborative effort between faculty at Yale, Children’s Hospital at Dartmouth-Hitchcock, and Boston Medical Center for quality improvement purposes.
Disclaimer: The “Eat, Sleep, Console” (ESC) Assessment Tool and Training Materials are copyrighted by Boston Medical Center Corporation, Dr. Matthew Grossman, Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic (2017). The ESC tool was developed for quality improvement purposes and is not currently the established standard of care for the assessment of infants with NAS. The tool is currently undergoing further rigorous study to assess maternal and infant outcomes. The ESC Tool should be implemented in the context of the standardized training provided, and always as part of a comprehensive non-pharmacologic care approach. At present, the ESC assessment tool and training materials are intended to be used only by hospital teams participating in the PNQIN or NNEPQIN collaboratives and are not available for use by hospitals outside of these collaboratives.
For Hospitals Participating in the NeoQIC or NNEPQIN ESC Roll-Out
**Please note that this page is password protected. If you need the password, please email Emilia Mannstadt at emannstadt@pnqinma.org.
Click here for information intended to help hospitals forming cuddler programs within their organization.
Please note this page is password protected. Please email Emilia Mannstadt at emannstadt@pnqinma.org. to obtain the password.
Boston Medical Center’s CALM Program is not accepting volunteers at this time.
Other programs that may be hosting volunteers are Lowell General, Salem, Massachusetts General, and Melrose Wakefield hospitals.
PNQIN does not coordinate volunteers for these cuddler programs. Please reach out to the hospital directly to confirm availability of volunteer opportunities.
PNQIN co-created a Patient’s Rights rack card and poster with individuals with lived experienced with substance use disorder (SUD) during pregnancy to support patients and families to advocate for themselves during and after delivery. The pamphlet addresses topics that were felt to disproportionately affect pregnant and birthing people with substance use disorder like peripartum pain management, perinatal mental health, birth control choice, and toxicology testing. The rack card aims to empower patients to take charge of their care while ensuring they are treated with dignity and respect.
View the Rack Card here.
Toolkits
The POP Project Team has developed a Neonatal NOWS Toolkit as well as a Maternal OUD Toolkit. These Toolkits can be seen below.
Neonatal Opioid Withdrawal Syndrome Inpatient Management Quality Improvement Toolkit: Revised November 2023
Perinatal Opioid Use Disorder (OUD) Management Quality Improvement (QI) Toolkit: COMING SOON!
Final edits are being collected now and the Perinatal OUD Management QI Toolkit will be posted soon.