Inter-Observer Reliability Of The Finnegan Neonatal Abstinence Scoring Tool In An Acute Care Setting

Sunday, June 15, 2014

Title: Inter-Observer Reliability Of The Finnegan Neonatal Abstinence Scoring Tool In An Acute Care Setting

Catherine M. Retskin, DNPc, MSN, RNC , Care Mangement, Mission Hospitals - Memorial Campus, Asheville, NC
Mary Ellen Wright, MSN, ARPN, CPNP , Women and Children's Health, Mission Hospital System, Asheville, NC

Discipline: Newborn Care (N)

Learning Objectives:
  1. Define inter-observer reliability as it relates to the Finnegan scoring tool and neonatal abstinence syndrome.
  2. List reasons why inter-observer reliability as it relates to the Finnegan score is important.
  3. Identify implications for nursing related to Finnegan scoring and neonatal abstinence syndrome.
Submission Description:
Objective:  The purpose of this study was to determine if inter-observer reliability of the Finnegan Neonatal Abstinence Scoring Tool (FNAST) exists among nurses who care for infants with neonatal abstinence syndrome in the NICU, Mother/Baby, and PEDS/PICU units of a regional tertiary hospital.

Design: This is a cross-sectional, inter-observer reliability study of the Finnegan scoring tool.

Sample:  A convenience sample of 122 nurses from the NICU, mother/baby, and PEDS/PICU units in a regional tertiary hospital was used which yielded 10 nurses from NICU, 65 nurses from Mother/Baby, and 47 nurses from PEDS/PICU. IRB approval was obtained before this sample for the protection of human rights.

Methods:  Participants were asked to complete a demographic survey that yielded information on primary unit of practice, education level, years of experience, and certifications. A video vignette of an assessment of an infant with NAS, which is part of an inter-observer reliability program developed by D’Apolito and Finnegan, was used with permission. After viewing the video, participants completed the FNAST based on their observations and assessment.

Implementation Strategies: N/A

Results:  The expert rater score of the vignette used for this study was 13. The overall median total score for participants was 12.76 with a SD of 3.306. The interclass correlation coefficient (ICC) relative to average measures calculated to determine the reliability of the participants’ total scores was excellent at 0.996. The ICC relative to single measures or how the score was obtained did not demonstrate reliability at 0.694. The area of greatest discrepancies was noted within the central nervous system portion of the scoring tool. Demographic data yielded 58% of participants had BSNs; 54% had 0-5 years of experience; and 46% were certified in their specialty.

Conclusion/Implications for nursing practice: Inter-observer reliability was established for total score. Inter-observer reliability was not established for single measures with the majority if the discrepancies found within the central nervous system portion of the FNAST. If clinical decisions are made based on the reliability of these scores, values should be a minimum of 0.90. Going forward, education in Finnegan scoring should have an increased focus on the central nervous system portion of the scoring tool. Recommendations also include that inter-observer reliability of the FNAST should be part of annual competencies and included in orientation for new nurses to the NICU, Mother/Baby, and PEDS/PICU units due to the epidemiology of NAS phenomenon.

Keywords:  neonatal abstinence syndrome, opiate withdrawal in newborns, Finnegan scoring tool, inter-observer reliability, interrater reliability

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