Improving the Safety of Administration of (Human) Expressed Breast Milk in the Neonatal Clinical Setting: A Large Hospital System Approach

Abstract: Improving the Safety of Administration of (Human)
Expressed Breast Milk in the Neonatal Clinical Setting: A Large Hospital System Approach
BACKGROUND: Addressing human breast milk feeding errors (reported) in 2006, a workgroup was formed to determine the variance and efficacy of (Human) Expressed Breast Milk (EBM) validation processes among neonatal clinical settings within a large hospital system. Inconsistent validation protocols existed for “Right Mom, Right Baby, Right Milk” education and competency. EBM feeding errors are Sentinel Events not largely reported or easily measured.
METHODS: A questionnaire was issued to Neonatal and Perinatal Directors within a large hospital system regarding the practice of validating EBM. Of 118 hospitals with perinatal services, 14 were identified as having a validation process using eMAR (electronic medication administration record) for non-medication items; of the other 104 were various protocols effective in creating a climate that offered safer administration of EBM¹. Of the 14 using eMAR, 4 common practices were identified: 2 involving pharmacy and 2 nurse-only applications. The pharmacy applications included order entry, bar-coding and label printing and discontinuation of the feeding order. The nursing applications included order entry, bar-coding and label printing, consolidation, validation and documentation. The workgroup described the ideal process as one which offered Pharmacy support and nursing validation at the point of collection, consolidation and administration.
RESULTS: It was determined by the workgroup the nursing application allowed for optimal, unit-based work flow and efficiency where meeting the needs of the mother-baby dyad was a primary goal. The goal was to streamline the process into a standard, nursing application, including a platform for information technology support. The Bar-coding of Breast Milk process is now a required practice with expected implementation by January 2008 for perinatal facilities within this large hospital system. The result has been the elimination of varied processes and the implementation of a standard practice for the administration of EBM.
CONCLUSION: This large hospital system delivers over 224,000 newborns per year. There is now a system in place which will assist healthcare workers in alleviating expressed breast milk feeding errors. Improvement in the quality of care delivered in the neonatal setting with a designed, standardized method to measure Performance Improvement efforts and capture “near misses” where Expressed Breast Milk feedings occur.

¹The scanning rates for all 14 hospitals employing eMAR for non-medication item validation range from 91.2% to 97.2% for 3^rd Qtr 2006.