TABLE 1

Timeline and Summary of Interventions

InterventionDates
Nonpharmacologic interventions
 Rooming-in2015
 Clustered care modelJanuary–April 2018
 Environmental changes including decreasing light and sound and increasing the use of rockers, pacifiers, and swaddlersJanuary–April 2018
 Shortening the NAS observation period from 5 to 4 d (hospital 2 only)November 2017
 Pulse-oximeter monitoring only for infants weaning on morphine (hospital 1 only)April 2018
 ESC Protocol
 Change to ESC scoringHospital 1, April 2018
Hospital 2, February 2018
 One-time morphine trialsFebruary–April 2018
 Flexible weaning schedules with ability to wean morphine multiple times dailyFebruary–April 2018
 Nursing template for nonpharmacologic care documentation Supplemental InformationPreliminary version live February 2018
Revised August 2018
Multidisciplinary education
 Extensive provider and nurse educationNovember 2017–March 2018
 Developed caregiver handouts emphasizing importance of rooming-in and nonpharmacologic care Supplemental InformationPreliminary version live October 2018
Revised August 2018
 Outreach to family practice providers, referring clinics, and CPS workersDecember 2017–ongoing
 MOC part 4
 MOC project involving 9 physicians with monthly case reviews and feedbackJuly–September 2018