Improving Performance: A Multidisciplinary Approach to NICU Breast Milk Utilization Pre and Post Discharge

Setting: At St Mary Medical Center, which is a 14 bed Community level 3 NICU with 300 admissions annually.

Smart Aim: Increase breastmilk utilization for all NICU admissions and promoting post discharge breastmilk utilization from our 2016 baseline of 52.84% and achieving and maintaining the goal of 62.84% by December 2018 which would be a 10% absolute gain.

Drivers of Change: Alignment with NICU nursing leadership, education of RNs on supporting lactation in the NICU, lactation team involvement and physician engagement.

Methods: Multidisciplinary team was established and processes developed, PDSA cycles initiated and audited. Processes developed included breast pump initiation within 6-12 hours of NICU admission with lactation consult including hand expression education, referral to Mommy and Me Breast Feeding Support Clinic at discharge and prescription for multivitamins at discharge.

Measurements: Lactation nurses completed daily audit for breast pump. Audited mandatory lactation consults, physician prescriptions, referral to clinic and any use of breastmilk at discharge for all infants discharged from the NICU.

Results: Breast pump initiation improved from a baseline of 33% to 89% with PDSA cycles. Lactation consult including hand expression reached 100%. Physician prescription for multivitamins went up from 52% to 100% Physician referral to Mommy and Me clinic went from 93% to 100%. Any Breast milk within 24 hours of discharge improved from 52.84 to 62.84%.

Discussion: Improvements were driven through nursing education during the first PDSA cycle and through lactation audits in subsequent PDSA cycles. Lactation support for hand expression, education, and facilitating physician`s referrals to breastfeeding support clinic led to significant improvements in use of breastmilk at discharge. Regular audits, staff education and teamwork were the key drivers to success.

Next Steps: Our future goals include monitoring of colostrum usage, lactation follow-up survey, and implementing donor human breastmilk.