Tiny doses, big impact: Optimizing sedation weaning to reduce opioid use in a Level IV NICU.

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.