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Tiny doses, big impact: Optimizing sedation weaning to reduce opioid use in a Level IV NICU
Tara Glenn1,2, Jeanne Carroll3,4, Amy Kimball3,4
1Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, CA, USA. tglenn2@rchsd.org.
Objective:
Infants in the NICU often require prolonged sedation, increasing risk for iatrogenic withdrawal. We aimed to reduce mean opioid exposure by 20% (26 to 21 days) by May 2023, with sustained improvement through May 2024.
Study Design:
A multidisciplinary team used the Model for Improvement with iterative Plan-Do-Study-Act cycles and EHR tools to implement a standardized sedation-weaning guideline. Applicable outcome, process, and balancing measures were analyzed using statistical process control charts.
Results:
Among patients receiving >4 days of opioids, mean exposure decreased from 26 to 17 days, length of stay from 70 to 50 days; and overall dexmedetomidine exposure from 18 to 12 days. Adherence to individualized weaning plans improved and feedback indicated effective withdrawal management.
Conclusions:
Standardized weaning reduced opioid exposure, LOS, and sedative use, enhancing safety, care quality, and NICU capacity.
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