Problem: Hypoxic Ischemic Encephalopathy (HIE), caused by acute perinatal asphyxia, is associated with high mortality and poor neurodevelopmental outcomes. The standard treatment, therapeutic hypothermia (TH), involves initiating passive or active cooling within six hours of life. At a Level III NICU, only passive cooling was utilized. No formal TH policy existed and in six cases of HIE, no evidence-based standard was consistently applied. Purpose: This quality improvement project aimed to enhance early HIE intervention in the NICU by implementing an evidence-based TH algorithm. Methods: Education was delivered via virtual presentation and informal interactions. Knowledge acquisition was assessed using pre- and post-tests. The project lead (PL) developed an evidenced-based TH algorithm and conducted weekly chart audits to measure real-time algorithm adherence, time to target temperature, and goal temperature achievement. TH mock cases, created by the PL, were distributed weekly to assess adherence using targeted questions. Data was stored in REDCap, a secure data management system. Annually, this project was predicted to benefit 3–6 infants, their families, nursing staff, and the hospital. Results: Of two infants requiring TH, adherence was observed in one case (50% adherence). Adherence based on case study performance averaged 57.9%. Overall, median adherence combining real-time TH infants and case studies was 68.35%, below the 80% goal. Some case studies showed strong performance; however, variable participation limited the measurement of widespread adherence. Conclusion: Despite moderate improvement in adherence, variability in algorithm use and low participation highlight the need for structured protocols, enhanced training, and workflow integration.