Table 1.

Timeline of Hospital-Level Initiatives to Improve the Care of Opioid-Exposed Mother-Infant Dyads

Time period	Participation in addiction treatment program required	Prenatal care requirements	Urine toxicology requirements: number of weeks without aberrant testing before deliverya	Breastfeeding eligibility guidelines and institution breastfeeding improvements
01/2006–12/2009	Yes	None	12	• 2006 First Written Breastfeeding Guidelines
01/2010–12/2012	Yes	≥12 weeks before delivery, no more than two missed visits	10	• 2010 Revised Written Breastfeeding Guidelines
				• 2010 Brochure on benefits of breastfeeding in OUD developed and distributed passively in prenatal clinic
01/2013–03/2015	Yes	≥12 weeks before delivery, no more than two missed visits	10	• 2013 NAS QI Committee formed; statewide QI collaborative started
				• 2013–14 NAS QI Committee focuses on standardization of monitoring of NAS infants and early pharmacologic treatment
				• Early 2015 NAS QI Committee reviewed breastfeeding guidelines
04/2015–12/2016	Yes	Attendance at ≥50% or ≥5 prenatal visits	4	• April 2015 revised breastfeeding guidelines approved
				• 04/2015 Started active face-to-face prenatal breastfeeding education
				• 2015 NAS QI Committee focuses on: (1) skin-to-skin, (2) rooming-in, and (3) lactation support, after mothers are discharged, but infant still admitted.

^aAberrant toxicology test defined as any nonprescribed opioids, benzodiazepines, amphetamines, or other illicit substances.

NAS, neonatal abstinence syndrome; OUD, opioid use disorder; QI, quality improvement.