PQCNC: Human Milk Initiative Phase II

45 bed single room design since September 2008

This is what inspires us. s s a sp es s

PQCNC Team

Data Collection Process

Data Display
Staff meetings Huddle Board QI Board Rounding g Newsletter

% patients receiving any HM in 1st 28 days October 2011-August 2012

100%

80%

60%

40%

% of patient receiving any HM 1st 28 days median

20%

0%

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% of patients receiving HM at DC October 2011-August 2012

100%

80%

% of patients receiving HM at D/C median

60%

40%

20%

0%

ct

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Cooler bag for every mom providing human milk

Resources

Lactation Support pp
Increased from 1.0 to 3.4 since October 2011 Dedicated hours for NICU daily

Freezer space.expanding di

Added d i dd d during PQCNC phase II

New Employee shadowing Lactation

Milk warming process

Milk storage bins

NICU Breastfeeding Resources

D
Colostrum for oral care

Feeding algorithm/intolerance guidelines

Act

Plan

Model for Improvement PDSA Planning Worksheet PLAN

Team Name: Cycle: 1 Date

Study Do

Objective for this cycle (What you hope to learn):

Specific questions to address: 1. 2. 3.

Predictions/Hypothesis (What do you think will happen when test is done?):

Plan for change or test: who, what, when, where, how:

Plan for collection of data: who, what, when, where, how, how long:

DO Carry out the change/ test. Collect data. Describe observations, problems encountered, and special circumstances. STUDY A l Analyze ( (quantitative and qualitative). S tit ti d lit ti ) Summarize what was l i h t learned. d

ACT Are we ready to make a change? Plan for the next cycle.

Combination of cycles

Plan:
Determine the safest way to warm human milk in our NICU

DO:
Review current practice Review recommendations for warming milk

Study:
Working with plumbing foreman to determine current water temperature and options Observation of warming practices in the unit

Act:
Decrease water temperature at nutrition station sinks Educate staff on safe warming practices Turn off instant hot water dispenser

Milk Warming Process PDSA Cycle

-110-115 at sink -153 instant hot water dispenser -Literature review 98 b t f warming h Lit t i 8 best for i human milk ilk -Varied current practice -Orlando Arenas (new best friend) ( ) -Email trail/link -Decreased water temperature at nutrition station sinks -Turned off instant hot water dispensers -Ultimately.we took Orlandos advice.

Currently 7 waterless milk warmers for patient rooms. Ordering warmers for every patient room. room

A few of our struggles.

Feeding Guidelines g
750-1000 gm Birth Weight
Birth Weight: ___________________
Day of Feeding mL/kg/day of feeds Interval Volume to be given

Place patient label here

NHRMC NICU Enteral Feeding Guidelines for Neonates

Date Started: _____________________

Date & Initials Comments

Day Day Day Day

1 2 3 4

Day 5 Day 6 Day 7

20 20 20 30 40 50 60 70 80 90 100
Fortify BM to 22kcals/oz. 90ml (1:50) or switch to 24kcals/oz formula

Q3 Q3 Q3 Q3 Q3 Q3 Q3

Day 8

110 120
*D/C TPN

Q3

Day 9

120
Fortify BM to 24kcals/oz. (1:25)

Q3

Day 10

130 140 150

Q3

Day 11

Q3

EPIC Ch ti Charting (working out the kinks)

Skin to skin Skin Nutrition assessment Lactation Notes

Still to come come.

Feeding Guidelines/Intolerance Algorithm Implementation Donor Milk Milk Tech Nutrition rounds N ii d Dedicated dietician support More freezer space