Increasing Nurse Awareness of a Breastfeeding and Substance Use Disorder Guideline to Improve Rates of Breast Milk and Skin to Skin Usage: A Quality Improvement Initiative​

Neonatal opioid withdrawal syndrome (NOWS) is related to opioid exposure in utero, and cases of NOWS have been increasing. In Tennessee in 2020, 824 newborns were born with NOWS. NOWS treatment involves pharmacological and nonpharmacological treatment. Breastfeeding, a nonpharmacological treatment, decreases the need and length for pharmacological treatment, the length of stay, and NOWS symptoms. Skin-to-skin may also reduce symptoms of NOWS. This quality improvement (QI) project involved implementing an Opioid Use Disorder Toolkit from the Tennessee Initiative for Perinatal Quality Care (TIPQC) and specifically educating staff nurses in a Women and Infant’s Department in a regional medical center on a substance use disorder and breastfeeding guideline. The guideline followed the American Academy of Pediatrics, Academy of Breastfeeding Medicine, and the Association of Women’s Health, Obstetric, and Neonatal Nurses’ recommendations that mothers stable on medication assisted treatment should be encouraged to breastfeed. Education occurred via an online educational module and display of unit flyers. A pre-and post-module survey was sent to nursing staff to assess awareness and use of the guideline. We saw an increase in awareness of the guideline from 91% to 97%. We also saw an increase in breastfeeding at discharge, a decrease in NOWS diagnosis, and a decrease in the length of pharmacologic treatment. Overall, this QI project helped increase nurses’ knowledge of breastfeeding in mothers with substance use disorders. We found a clinically significant decrease in NOWS diagnosis, a decrease in the length of treatment, and an increase in breastfeeding rates at discharge