Effectiveness of Eat, Sleep, Console Implementation in Neonatal Intensive Care, Mother-Baby, and Pediatric Units

Abstract

Background: Eat, Sleep, Console (ESC) can identify infants experiencing neonatal abstinence syndrome (NAS) and appears to be the better method of assessing the treatment threshold for these infants than the traditional method of Finnegan Neonatal Abstinence Scoring Tool (FNAST). Evidence suggests implementing ESC may decrease length of stay, decrease opioid exposure, and increase use of non-pharmacologic treatment modalities. Problem: In neonates with NAS, utilizing FNAST results in initiation of morphine administration around the clock (ATC) protocol once the infant meets the threshold requirements. FNAST is not a patient-focused model of care. Methods: Retrospective chart review. Inclusion criteria: Infants born greater than or equal to 35 weeks gestational age with a diagnosis of NAS and admitted to Mother-Baby Units, Neonatal Intensive Care Units, and Pediatric Unit. Exclusion criteria: Infants born less than 34.6 weeks gestational age and admission diagnosis that would increase length of stay longer than NAS (ex: sepsis). Conclusion: Implementation of ESC changed the culture of each unit to focus more on non-pharmacologic comfort measures and parental involvement. Overall, ESC implementation decreased LOS by 2.48 days, number of morphine doses administered by 21.56 doses, and total hospital costs by $2,873.70 without increasing 30-day readmission rate.