Purpose for the program: The purpose of this program was to implement cue based feeding in our NICU.

Proposed change: Achievement of full oral feeds is often times the last milestones reached prior to discharge from the NICU. Many NICUs still used a scheduled feeding method to initiate and progress oral feedings. Several studies have come out to support that a cue based feeding approach, also known as an infant driven approach, may help the NICU infant achieve full oral feedings up to six days sooner than a scheduled feeding method.  A cue based feeding approach tailors the progression of oral feeds for each individual, with close attention paid to the infant’s developmental cues to decrease stress. The following outlines our transition from scheduled feeds to cue based feeds.  

Implementation, outcomes and evaluation: We introduced a cue based feeding program in our 83 bed, level three, metropolitan NICU, which has over two hundred nurses and staff. This was achieved with a multidisciplinary team approach.  Staff education was given by nurses including one team leader and four super-trainers on each shift. Education was given in the form of bedside in-services, updates in the unit newsletter, a nursing policy/guideline, and a CE offering. The education ranged in topics such as benefits of cue based feeding, how to read infant cues, how to use a cue based feeding scale form, educating parents, and trouble shooting. After implementation, bedside charts were audited to assess  staff compliance with cue based feeding and address  issues. Concerns and common issues were addressed in the form of bedside in-services, Q&As, updates in emails and newsletters, as well as  focus groups on each shift. A multidisciplinary meeting was called six month after implementation to address concerns and update the program. 

Implications for nursing practice: Now, cue based feeding has become a common language in our unit, and is considerd a success. Research is currently underway in our unit to assess time to full oral feeds, and impact on direct breastfeeding rates. Future research to consider is cue based feedings impact on oral aversion after discharge.

Keywords: cue based feeding, infant driven feeds, NICU, feeding