Breast feeding promotes the mother-infant relationship and provides the best nutritional support to the infant.  For the infants born with medical needs requiring admission to the nursery or Neonatal Intensive Care Unit (NICU), breast milk may be expressed and stored until the time of administration.  The Northern Westchester NICU/Nursery Nursing Shared Governance Council identified an opportunity to improve practice and meet quality standards to decrease the potential for administration errors. 

Proposed change:

The proposed concept of electronically scanning bar-coded labels, to identify stored expressed breast milk (EBM) in place of hand written labels verified by two nurses, evolved.  Utilizing the existing electronic medical records system in an adaptive manner allowed increased time for the delivery of patient care.

Implementation, outcomes and evaluation:

Through an interdisciplinary approach, a process was developed incorporating the rights of medication administration and bar-coded label use to improve the efficacy of stored EBM administration.  A work flow algorithm defines the system’s steps and user accountabilities.  A physician’s order initiates the process: generating the first bar-coded EBM label. Parental involvement is essential to the appropriate identification of stored EBM.  The parent receives the bar-coded labels from the nurse after the two patient identifiers, name and date of birth, are verified.  It is the responsibility of the parent to label each EBM container with a bar-coded label and date and time of pumping.  The nurse is accountable for scanning EBM into the electronic medication record at the bedside.  A corresponding policy was approved and distributed.  A staff competency tool was completed prior to implementation of the new process.

The process was well received. An initial audit of stored EBM administration over four weeks indicated 92% compliance with the process.  The compliance goal for this initiative is 100%.  The staff has been provided with ongoing education and support.  The unit has remained error free. The Nursing Shared Governance Council is reviewing EBM warming practices to further enhance management of expressed breast milk.

Implications for nursing practice:

Neonatal nurses are strong advocates and voices for the smallest of patients.  The implementation of the electronic bar-coded label process in EBM management supports practice change to improve the quality of infant care, increase parental confidence, and secure patient safety.  The use of this technological advancement can be applied to other instances of body fluid verification, such as blood administrations, to prevent errors.

Keywords:

 expressed breast milk, shared governance, bar-coded labels, parental confidence, patient safety