From the 2024 HVPA National Conference
Muna Shehadeh BS (Johns Hopkins Aramco Health Care)
Introduction
Human breast milk is the best source of nutrition for infants, but it is particularly important for preterm infants, studies indicate that it reduces the incidence of necrotizing enter colitis, respiratory tract infections and sepsis, while improving feeding tolerance and promoting cognitive development.
Feeding infants in a Neonatal Intensive Care Unit often requires a process of handling, storing and administering Expressed Breast Milk (EBM). This process can introduce problems of improperly handled or expired EBM. In addition, in the Islamic faith, breast milk from someone other than the mother established a foster mother relationship with the child. Thus, it is imperative to ensure adherence to strict process controls.
International best practices for the safe, proper handling of EBM are readily available. These best practices emphasize the importance of preparation, staff training and proper identification and storage.
Problem Statement
Administering the correct breast milk to hospitalized infants is essential, team conducted study on EBM administration and the result showed low compliance of barcode scanning of EBM before feeding the infants.
Data collected during March to May 2023, the compliance rate for barcode scanning is 72%, therefore, CUSP team decided on improvement project to improve the compliance to Barcode scanning of EBM to ensure proper Identification of EBM before administration.
Aim
The purpose of this study is to assess the EBM administration process in the JHAH NICU and to implement process improvement initiative to ensure a minimum compliance to JHAH EBM guidelines of 90% by October 2023.
Methodology
A Specialized multidisciplinary team was formed comprising representatives from Nurses, Neonatologist, and other health provider aligned with process improvement expert. The team used the PDSA Problem solving model.
Baseline assessment included review of patient medical records for 3 months regarding compliance with barcode scanning and administration of EBM, the team found a 72% compliance to existing guidelines.
Current practice was reviewed, Root Cause Analysis was conducted.
Problem areas included.
- No specific guidelines were in place.
- No KPI for EMB Labeling
- Existing labeling was not machine readable.
Actions
Based on the gaps identified during the RCA, a Process improvement plan was developed that included
Adherence to good hand-hygiene practices and use of “no touch” preparation and administration techniques
EBM storage and handling education materials are provided to parents.
Use of dedicated staff for the handling and preparation of human milk feedings within the health care setting is considered a best practice and has been shown to reduce risk of misadministration errors.
Perform a two-person double check of a minimum of two-patient identifiers or use bar code scanning technology to confirm that all bottles of human milk belong to the same patient before feeding.
Stored milk should be rotated using first-in-first-out (FIFO) principles with the oldest milk being used first.
Fresh milk be stored in the refrigerator (≤ 4°C or ≤ 39°F) for a maximum of 48 h
Frozen human milk be stored in the freezer for 6–12 months at ≤ −20°C (≤ −4°F).
Result
Post implementation data indicate that compliance with barcode scanning guidelines as of December 2023 was 96%. In addition, the handling and storage of breast milk procedures has improved significantly.