Document Type

DNP Project

Publication Date



Background and Review of Literature: Neonatal abstinence syndrome (NAS) is becoming an increasingly complex problem across many facilities. The use of standardized assessment is vital to ensuring that infants are properly assessed and managed. The use of the Finnegan or modified

Finnegan score has been the most common method for assessing infants but lacks statistical validity or reliability. It also suffers from a lack of interrater reliability. This technique also requires that an infant be disrupted at least every four hours to look for signs of withdrawal. A new model called Eat, Sleep, Console Approach (ESC) is evaluating the importance of first line interventions such as cuddling, swaddling, breastfeeding on demand, and low stimulation environments. The model focuses on a neonate's ability to maintain vital functions.

Purpose: The purpose of this project is to find a new approach to assessing NAS that will enhance the ease and reliability of NAS assessment.

Methods: A pre and post assessment survey of frontline staff will help to determine how implementation of the new model improves care and assessment.

Implementation Plan: Implementation of this project included a PowerPoint training to help ensure that staff can utilize the new assessment technique. A side by side comparison of the Finnegan scoring and ESC model was done with both assessments taking place on each infant. Surveys will evaluate the before (Finnegan) and after (ESC) to see if staff perceive one method as superior in simplicity and reliability.

Conclusions: ESC model has been well received by staff on the unit. It has been a better way to decrease interruptions for neonates and is perceived as an easier alternative to Finnegan's scoring.


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