Author: Kim Carmignani, MSN, RN-NIC
In the neonatal intensive care unit (NICU) setting, we look at evidence-based practice to develop and implement guidelines and recommendations that will advance our practice, enrich our care, and promote patient safety.
The newly released Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities, third edition,1 has done just that. As a director of a large level IV/III NICU, I am looking to these guidelines to help drive our focus on the best evidence for storing, mixing, and delivering human milk to infants. The guidelines provide strategies to ensure patient safety, which is in the forefront of everyone’s minds in the health care setting.
In chapter 5 of these guidelines, there are specific sections that address the ordering of feedings and the importance of communication between those preparing the milk and the bedside nurse. This communication is “essential to avoid waste and prevent errors.”1
In my institution, we do not utilize the overfill method in order to utilize all human milk with no waste. These guidelines review the risks and benefits of different styles of milk preparation and initiatives that reduce the potential waste of human milk. It has also been my experience that breastmilk scanning and checks to ensure safe delivery of milk to babies has fallen behind many other safety initiatives in the NICU. Electronic Medical Records (EMRs) have the capability for scanning medications and blood products; however, they do not all have the ability to aid in the correct identification of human milk. The use of barcode scanning after the appropriate labeling of milk is becoming a standardized practice in the NICU.
EMRs may have built-in programs or offer software application programs that can be purchased separately. There are several advantages when utilizing these programs, including reduced need of extra staff for two-person verification and tracking of lot numbers. We have implemented many strategies to ensure the safe delivery of human milk to the correct baby in our NICU.
The new guidelines describe the appropriate labeling of human milk and milk products by affixing two unique patient identifiers to decrease the risk of misadministration of breastmilk to the wrong patient. Chapter 13 provides additional quality indicators for preparing and feeding safety, as well as a sample flow chart to track milk inventory. The current feeding in our NICU is based on overwhelming research outcomes that support the use of mother’s own milk, donor human milk, and human milk-based products. The “how to” on safety and efficiency is well outlined in the guidelines. It is necessary for NICU caregivers to review and utilize these guidelines as we continue to work towards ensuring the best quality and safe feeding practices for all babies.
1. Pediatric Nutrition Practice Group; Steele C, Collins EA, eds. Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities. 3rd ed. Chicago, IL: Academy of Nutrition and Dietetics; 2018.