Author: Tamyra Rae Hoff, RN, MS, NE-BC The much-anticipated revised guidelines for infant and pediatric feedings1 has provided not only support for the current practice, but also a roadmap for continued and newly developed best practices to drive patient safety. As a nurse leader, it has been an amazing journey moving from mixing milk in what could be best described as a state-of-the-art human milk mixing lab.
The guidelines provide a very clear blueprint of what the expectations should be for handling human milk while also providing insights into best emerging practices. As a unit, we have had the good fortune of a designated human milk lab and modeled it after the previous edition of the guidelines in developing the facility, procuring the equipment, and staffing the team. With the new guidelines, we can prepare for the future milk lab. The greatest area of clarity with the new guidelines comes with the description of the physical facilities. The idea of having a space that would separate the dirty process from the clean process seems a bit obvious, but this is not something that we built into our milk lab. Having a separate mixing area where aseptic techniques can be maintained is critical in the safe preparation of human milk. Finally, the new guidelines also highlight the required equipment in the milk lab. This is an area that we focused a great deal of attention on when building our unit. We have transitioned away from food-grade freezers and to freezers that are built to maintain lower freezer temperatures. We built our original lab with a dishwasher that we have used for non-mixing supplies such as milk bins. We now have utilized the information in the equipment section to identify a dishwasher that will reach the established temperatures, enabling us to utilize reusable mixing containers rather than disposable items. The information provided in the guidelines is critical to the safe and efficient operation of our milk lab. In a recent Joint Commission survey, our milk lab, processes, and personnel were under a great deal of scrutiny. Our implementation and adherence to practices established in the previous edition of the guidelines enabled our unit to pass without difficulty. The surveyor did offer suggestions that will address the new information presented in this edition. Each unit has to take the guidelines and implement a program that is feasible with the space and resources available. Having a milk lab has provided a great deal of consistency in the mixing process and in meeting our patient safety goals. We are very fortunate to have such a resource available. Reference: 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.
Pam Middleton, RN, BSN, MPA
The book identifies regulatory requirements and quality indicators such as "The Joint Commission’s Provision of Care" guidelines for enteral feedings. This edition also provides an abundant number of sample templates to guide and hasten implementation of using human milk feeding in the NICU. I highly recommend reviewing this book before starting the task on your own.
Kim Carmignani, MSN, RN-NIC
In chapter 5 of the guidelines, there are specific sections that address the ordering of feeds and the importance of communication between those preparing the milk and the bedside nurse. This communication is “essential to avoid waste and prevent errors.” The guidelines review the risks and benefits of different styles of milk preparation and initiatives that reduce the potential waste of human milk.
Amy Mailand Paradis, NNP
Chapter 7 reviews practices associated with donor milk and donor milk products, along with cautions concerning milk-sharing. Most notable are the various pasteurization techniques used in producing these products. Chapter 11 provides guidance on common clinical issues such as barcode scanning and two-person verification of every container transfer and prior to feeding to avoid administration errors.