NAS, How do you score?

NICUmiiki, DNP, NP · Sep 15, 2015

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.

luvmybabes · Sep 15, 2015

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.

BittyBabyGrower, MSN, RN · Sep 15, 2015

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.

karnicurnc, MSN, APRN, CNS · Sep 21, 2015

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.

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tinkerbell419 · Sep 21, 2015

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

Elvish, BSN, DNP, RN, NP · Sep 26, 2015

We do the Finnegan as well. Occasionally (several times per year) they'll have us do a couple scores with a second person to make sure our scoring style hasn't wavered much. Same as a PP mentioned, to increase inter-rater reliability and ensure we're dosing/weaning appropriately. On a day-to-day basis it's just one person.

Our orders are also to start meds if 3 consecutive scores 8 or higher, or 2 consecutive 12 or higher.

denicu · Sep 27, 2015

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.

denicu · Sep 27, 2015

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.

Elvish, BSN, DNP, RN, NP · Sep 27, 2015

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.

We have used Morphine + Phenobarb successfully for years. Clonidine we've used in the last year or two, also with pretty good results. We give the meds on a schedule, not prn. Clonidine q6, morphine q3, and phenobarb qday.

I'm curious about rechecking the NAS after an hour. If the baby is sleeping after I've medicated him he's probably not going to be scoring an 8, and waking a NAS baby on meds an hour after medication seems counterintuitive. Where I am we do an N-PASS (sedation score) with any opioid both with administration and 1hr post, but this doesn't require me to wake the kid. I'm curious what the rationale is behind another Finnegan an hour post-medication.

denicu · Sep 27, 2015

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.

BittyBabyGrower, MSN, RN · Sep 28, 2015

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