NAS, How do you score?

There's no second RN... The score is just what the nurse says it is. Those babies get scheduled narcs to wean, so the score (over time and multiple RNs) is an indicator of whether or not the dose can be weaned. High scores do allow us to increase the does.

Thanks for the input. We only start morphine if they have 3 scores above 8 or 2 scores above 12. We have new nurses that I feel don't understand the scoring system.

We do a second scorer with our new nurses. They were scoring for things such as a 32 weeker, who doesn't nipple well or old excoriations, or a kid with lung disease having a high respiratory rate and retractions.

Inter-rater reliability training can improve the accuracy of scoring and boost the confidence the providers have in the nursing staff related to scoring. I have read several research articles that use this training.

Neo Advances

We use NAS observation scoring sheets. I cant remember the specifics but we score if we notice things like high pitched cry, stiffness of limbs, sucking of fists, tremors disturbed or undisturbed, inability to be consoled etc. I believe that oral morphine is started at 40 micrograms per kilo and reduced accordingly to scores

I work in a 20 bed NICU and 25% of our babies suffer from NAS. How does your facility handle scoring these babies? We use the Finnegan scoring system and recently they decided they want us to check our score with a second RN if the score is 8 or >. I have been doing this since 2002 and i am insulted that my judgement is being questioned. Just wondering how other facilities handle this situation.

I think Finnegan scoring system is the universal system that is used. As for the 2nd RN check, I think its a great idea. I just came from a unit that has quite a few withdrawal babies . I usually work nights and I try to keep the environment as quiet as possible and my score tends to be lower. I will come in 12hrs later and the scores are way higher and infants has increase dose of morphine so I dont mind the 2nd RN checking the scores with me. Last wk I attended the ANN conference in Orlando and NAS was one of the most popular seminars. Some units do use the 2 RN check, sending babies home on low dose Morphine, the use of Morphine and Phenobarbital as well as Clonidine to treat these babies.

Something new that was being done at the above unit-if score is above 8, medicate as ordered (morphine is usually q 3hrs) and re-evaluate in 1 hr which means waking baby up to do the score again. If still above 8 call MD.

The thinking is that if scores have not gone down since last medication was given then there is a possibility that infant may need an increase dose. Didnt make sense to me but this is what they do and it started shortly before I left the assignment.

Our nursery wakes them up, we don't. Let sleeping screamers sleep! I don't really get the rationale either.

We don't wake them up. That's crazy. We score them since the last score. If at any point since the last score they exhibited any of the behaviors, they get points for it.