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Children's National Health System

Children's National Health System, Washington, D.C.

TEAM: Neonatal Intensive Care Unit

CATEGORY: Best Expertise

ENTRY SUBMITTED BY: Judith Campbell, RNC, IBCLC, lactation consultant

Our neonatal intensive care unit (NICU) nursing team at Children's National Health System has been working on a continuous quality improvement initiative to increase the number of patients receiving breast milk. This presents a special challenge in a NICU with a high acuity level, since the patients in our care are so vulnerable and may stay for extended periods with risk of serious complications. 

In the first phase of our project, six NICU staff nurses earned certification as International Board Certified Lactation Consultants (IBCLCs) to inaugurate our Lactation Resource Nurse Service. This was followed by several nursing initiatives to support the use of lactation technology (pump rentals, scales, creamatocrit and nipple shields). Dedicated breast milk refrigerators were placed at each bedside. Breast milk freezers were placed in conveniently located nourishment stations and a secure nourishment room complete with deep freezers devoted to milk management. Mothers were welcomed to pump at their baby's bedside or in an airy room with private spaces stocked with supplies and other necessary equipment. This was followed by the creation of a full-time dedicated RN IBCLC position.

Our team is empowered through staff education including inservices, mentoring, monthly e-newsletters and our interdisciplinary NICU Human Milk Oversightteam, chaired by nurses. This panel is committed to valuing breast milk and breastfeeding as a critical contribution to the recovery of our patients. 

We have implemented many improvements through this collaboration, including expanded parental education; colostrum labeling for chronological feeding; weekly bilingual mother to mother support groups; electronic orders for lactation consults; use of donor human milk; improved practices for reducing potential loss of milk; advocacy for appropriate breast pumps outside the hospital (including at our local Ronald McDonald House); use of colostrum for oral care; providing meals for lactating mothers; equipment and furniture upgrades; a milk management system managed and monitored weekly by a small team of nurses; and use of a breast milk barcoding system which is considered the gold standard for patient safety.

Implementation of our projects is guided by monthly data, initially using estimated volumes of breast milk fed, with chart review of about half of the monthly discharges. We then changed our approach to use data reflecting percentages of patients discharged on breast milk.

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Data assessment has confirmed that the efforts of our NICU nursing team are worthwhile: Our statistics validate that breastfeeding and breast milk feeding are a high priority in our NICU. Initial data shows a 1,000% increase in volumes of mother's milk fed over a period of 18 months. We've also found that the mean percentage of patients who had been admitted to our NICU at less than a week of age and were discharged on breast milk between the third quarter of 2011 and the fourth quarter of 2013 was 62%.  Recent monthly reports show that the mean through the beginning of the third quarter of 2016 is 80%; an 18% increase!

These findings demonstrate that establishment of a strong breast milk culture by an educated team of nurses has a significant impact on quality of care. We are thrilled this initiative has contributed to empowering our community's families while in our care. As an added benefit, the monthly data have provides feedback to our team that a nursing-led patient care project can improve our standing in national NICU rankings. We have found this success to be very motivating for all of us. 

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