Do your peds floors take drug withdrawl babies?

[NicuGal, MSN, RN]

Am asking this because we are seeing a huge influx of these kids into the NICU. The nursery turfs them to us because they claim they don't have the staff to take care of them. We started having the fellow go over to check the kids out and would write the orders for morphine per our protocol. Well, we would get a call saying the baby was seizing, no joke, every single kid we get from them, this is what they say, because we have to take the baby. We get the baby, who is screaming, never see a seizure. Right now we have 10 of these poor souls. Next to PPHN or micro preemies, screaming. We have peds cribs all over the place as they are here for months sometimes.

In a division meeting it was brought up to send the kids on the last tail of their taper to peds. Peds said no way, no peds floors take those kids. Really? And it is appropriate to keep them in an ICU at $1200 a day next to sick kids? One of our peds floors is regularly closed and their staff is often taking PTO time and are in jeopardy of losing FTE positions.

So, do you all take these kids? Or do they just stay in NICU or the nursery forever? It is a tough situation!

[zeus&lincoln]

I know in my hospital we (NICU) get all NAS babies. The only time they "leave" our unit is to go to the level 2 NICU. You are 100% correct, some of these kids are sick as snot, while others are just weaning and screaming, no other complications. It would be interesting to see how other hospitals handle this. Also, we keep those babies in private rooms, not pods so that they can scream their heads off and be less likely to bother our really sick kiddos.

[NotReady4PrimeTime, RN]

I can't speak specifically about NAS babies, since I work PICU these days but I can tell you that a LOT of our cardiac kids end up in withdrawal after being sedated within an inch of their lives for weeks on either morphine or fentanyl and usually midazolam. Once we get them to extubation we start weaning their drugs, using oral morphine and oral lorazepam. When they're not requiring ICU-level care any more, they go to the peds cardiology floor. No ifs, ands or buts. A few of them even go home with morphine and lorazepam if they don't need round-the-clock nursing any more.

[DisneyLoveRN]

We rarely get these babies on our peds floor. When our census drops we float, a lot of times to NICU. I once suggested bringing these babies to our floor and almost had a pediatrician rip my head off.

[NicuGal, MSN, RN]

We have even said it would be better for them as our rooms are private on peds and it would be better for them. They also have more child life people and cuddles than we do. I just feel bad for all the kids. An ICU is just not a good place for them, neither is the NBN. I really don't understand the resistance.

[classicdame, MSN, EdD]

we do. Has nothing to do with behavioral issues as is the case with adults.

[meanmaryjean, DNP, RN]

I know in my hospital we (NICU) get all NAS babies. The only time they "leave" our unit is to go to the level 2 NICU. You are 100% correct, some of these kids are sick as snot, while others are just weaning and screaming, no other complications. It would be interesting to see how other hospitals handle this. Also, we keep those babies in private rooms, not pods so that they can scream their heads off and be less likely to bother our really sick kiddos.

BBM: 'weaning and screaming' IS a complication. I read somewhere of a program where they have volunteers to tend these 'not unstable' NAS kids- (under the direct care and supervision of RNs of course) and all the volunteers are from the deaf community. Which is brilliant.

[ixchel]

Our hospital has a special care nursery (lost nicu status last year), and they keep their NAS babies. The hospital has been moving entire units in the last couple of years due to expansion and renovations, and there is a huge rallying effort to put a NAS unit that is family centered (parents stay on the unit while baby stays) on a presently vacant unit since we've had so many NAS babies. Hopefully the hospital looks beyond profit lines and decides to do it. The floor that it would potentially occupy would otherwise sit vacant until someone had a better idea.

[zeus&lincoln]

BBM: 'weaning and screaming' IS a complication. QUOTE= "meanmaryjean; 771461"]

I am 100% positive that I wrote NO OTHER COMPLICATIONS not that weaning and screaming were not complications, please don't misquote me. I wrote exactly what I meant to say. We do plenty of NAS scoring on kiddies and have a wide range of severities from symptoms. Ranging from seizures, irritability, poor feeding, etc. However, many do not belong in an icu. Our special care nursery does a brilliant job with these special ones.