ABSTRACT
Purpose/Objectives: It is well established that breast milk provides newborns with nutritional support, improved immunological defense, and better neurodevelopmental outcome. The American Academy of Pediatrics (AAP) recommends breastfeeding for 6 months and it is imperative that we as neonatal providers, promote and help sustain mother's breast milk supply so that upon discharge, these mothers may achieve this goal. Premature or Very Low Birth Weight (VLBW) infants tend to be sicker and unable to feed immediately. These challenges, paired with their critical illness in the Neonatal Intensive Care Unit (NICU), along with maternal stress and separation from the infant, makes meeting the AAP recommendation a challenge. On review of our data (demographics: 62% African American, 27% Hispanics, 8% Caucasians), we found that only 55% of babies discharged from the NICU at University of Illinois Hospital (UIH) received any breast milk at the time of discharge, while only 31% of VLBW infants received any breast milk at discharge. This identified an opportunity for improvement for our NICU in September 2019. Design/Methods: Our quality improvement (QI) initiative aimed to improve the rate of maternal breast milk administration at discharge by 8% by August 2022 for newborns born <34 weeks or <1500 grams admitted to the UIH NICU from birth. Our multidisciplinary team included physicians, nurses, and dietician. We used the Institute of Healthcare Improvement Model for. Change and Process maps and Key Driver Diagrams to develop and identify interventions. Tests of change were conducted using plan-do-study-act (PDSA) cycles targeting interventions such as increased maternal support by providing an early recognition reward trinket for breast milk, improving EMR handoff, and providing a lactation bundle. Process measures (documentation, checklist), balance measures (time to first feed, length of central line, length of stay), and our overall outcome measure (improving breast milk administration at discharge) were identified and data was collected and presented as control charts with statistical analysis. Results: Although we have yet to see a statistically significant shift, we have achieved ∼30% of our targeted aim and see a trend towards desired outcome, Figure 1. The project has gained momentum from all key stakeholders and frontline staff, leading to ownership and pride in the project. Conclusion/Discussion: Although the COVID-19 pandemic caused the initiative to slow down, the continual conversation surrounding the project, played a large component in changing the culture around breast milk and has potentially impacted outcomes, Figure 1. On feedback from the medical team, the morale and quality of conversations with bedside RN regarding mother's milk supply had increased. We have made steps in the right direction, but there is still much work to accomplish. Moving forward, this initiative will work towards achieving our aim, a sustainability phase, and expand to other departments.