Date of Degree
Fall 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Brandee Temmis
Abstract
Problem: Opioid use in pregnancy continues to rise, leading to increasing cases of neonatal abstinence syndrome (NAS). Traditional management with the Finnegan Neonatal Abstinence Scoring System (FNASS) often results in pharmacologic treatment, prolonged hospitalizations, and higher costs. Inconsistent FNASS scoring at the hospital system contributed to unnecessary NICU admissions and variable outcomes. Eat, Sleep, Console (ESC) was introduced as an alternative approach, but its effectiveness had not been formally evaluated.
Aim of the Project: The aim of the quality improvement initiative was to evaluate the effectiveness of the ESC model in improving outcomes for infants with NAS across three hospitals in Central Ohio, focusing on length of stay (LOS), pharmacologic treatment rates, NICU transfers, costs, and documentation compliance.
Review of the Evidence: Evidence supports ESC as a family-centered, nonpharmacologic care model that reduces LOS, decreases medication use, and lowers costs. Meta-analyses and multicenter studies demonstrate consistent improvements in outcomes compared with FNASS-based care.
Project Design: A quality improvement program evaluation was guided by the Kirkpatrick Model at levels two through four, supported by a logic model framework. Data were collected retrospectively and prospectively over a 10-week period and analyzed outcomes, process adherence, and financial impact.
Intervention: ESC was implemented for infants ≥36 weeks’ gestation with prenatal opioid exposure. Care focused on three functional criteria: ability to eat, sleep, and be consoled. Nurses documented nonpharmacologic interventions and caregiver involvement. Huddles were initiated when infants had difficulty meeting functional goals, with escalation to NICU transfer if needed.
Significant Findings/Outcomes: Compared with FNASS care, ESC reduced LOS from 16.7 to 8.8 days, which is lower than the national average of 10 days. The pharmacological treatment rate decreased from 54.2% to 37.5%. NICU transfers dropped by 8.9%, from 55.6% to 46.7%. Average room and board costs declined from $152,534 per patient to $69,396 with ESC and $17,781 for ESC-only infants. Documentation compliance reached 87.5%.
Implications for Nursing: ESC demonstrated improved infant outcomes, decreased healthcare costs, and enhanced family engagement. Nurses played a pivotal role in implementation, education, and documentation. Findings support ESC as a sustainable, evidence-based standard of care that aligns with organizational goals of quality improvement, patient-centeredness, and cost efficiency.
Recommended Citation
Fout, Amanda, "Eat, Sleep, Console Care for Infants with Neonatal Abstinence Syndrome: A Multisite Evaluation" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 40.
https://fuse.franklin.edu/dnp-project/40
Rights
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