TABLE 1

Leverage Points, Interventions, and PDSA Cycles

Leverage PointInterventionPDSA CycleDate
Prenatal maternal educationPrenatal pamphlet given to obstetrician and Subutex clinics1September 2016
RN visit to Subutex clinics
Improving maternal drug screening and infant testingUniversal screening questions on admission to L&D1September 2016
Umbilical cord testingDecember 2016
Improving infant assessmentsTraining sessions for pediatric and L&D nurses on FNASS on newborns schedule1September 2016
Improving family engagement, understanding, education, and involvement in infant’s careAdmission packet for families with clear expectations and agreement letter1October 2016
Nonpharmacologic treatments for infantsLow-stimulation environment, donor breast milk, and cuddler program1October 2016
Provider education for pediatric hospitalists, FP resident or attending physicianGroup meetings and 1-on-1 sessions1October 2016–May 2017
Medication and protocol changeTransition from methadone-weaning protocol to morphine as needed2March 2017
Infant assessment changeTransition from FNASS to ESC3August 2017
Infant weight lossMaximize feeding and calories with nasogastric feeds4Ongoing from April 2018
Infant-based feeding readiness and quality score
NEWT in EMR
DHM
  • FP, family practice; NEWT, Newborn Weight Loss Tool; RN, registered nurse.