Perinatal Quality Collaborative of North Carolina NCCC Collaborative Action Plan Exclusive Human Milk in Newborn Critical Care

Centers Primary Drivers

Relates directly to getting the desired results AND outside the focus of this collaborative action plan 1. Create supportive and family-centered environment Action: a. Perform self assessment and implement family centered care practices b. Welcome 24 hour parent care in nursery c. Develop family support programs d. Provide pumps and pumping rooms for mothers before and after discharge a. Monitor daily intake and multiple parameters of growth b. Utilize a multidisciplinary team, including neonatal nutritionist and pharmacist c. Early initiation of TPN (protein within 2 hours, lipids in first 24 hours) a. Evaluation for oral feeding (baby readiness) b. Teach infant cues c. When transitioning to exclusive breastfeeding consider measuring milk transfer, and use Supplemental Nursing System (SNS) and/or nipple shields as needed d. In preparation for discharge establish feeding regimen to meet growth requirements and developmental needs, identify and connect to community resources, consider rooming in prior to discharge and consider baby weight scales for use at home to measure milk intake a. Emphasize breastfeeding in group prenatal patient education b. Collaborate to assure breastfeeding support groups for outpatients c. Promote breastfeeding support in the greater community, with special attention to underserved groups Actions:

Secondary Drivers

2.

Optimize nutrition and nutritional monitoring of all infants.

3. Support the mom & baby to breastfeed

4. Promote Breastfeeding support in the community

A. Promote and use mothers milk as the preferred nutritional substrate for infants 1. Assess feeding intention and establish expectations related to premature birth upon admission

2. Provide early and continuous support to obtain mothers colostrum and milk

3. Promote regular maternal skin to skin contact

a. Inform all mothers at time of birth of benefits of their milk for their baby including mothers milk as medicine b. Use language that distinguishes providing milk from breastfeeding c. Encourage early initial visit to facilitate communication and assistance to obtain colostrum and milk a. Provide mother with access to appropriate pump (hospital-grade with double pumping kit) and provide necessary supplies b. Teach breast massage and relaxation techniques c. Teach hand expression & pumping techniques using mechanical pump d. Provide support from lactation consultant or other breastfeeding expert e. Provide daily review of mothers records of pumping and volume expressed a. Provide staff & parent education to promote skin to skin b. Encourage early maternal visits to include touch and skin to skin as soon as possible c. Encourage breast pumping immediately after each skin to skin interaction with mom d. Encourage non-nutritive sucking at the breast

B. Implement feeding guidelines

C. Safety in the use of expressed human milk 1. Labeling, storage and administration of breast milk

2. Use of donor milk

D. Health System Leadership 1. Executive Leadership

e. Provide appropriate chairs and privacy screens for skin to skin and breastfeeding opportunities Actions: a. Provide early small volume feeds using moms colostrum every chance you get as soon as you get it b. Consider using pasteurized donor milk until moms milk is available c. Develop unit specific systematic feeding advancement guidelines including but not limited to volume, fortification, use of additional protein and an algorithm for residuals Actions: a. Adopt and follow national guidelines to include, but not be limited to type of containers, labeling protocols, and refrigerator/freezer temperatures b. Develop policies for the administration of breast milk to include, but not be limited to recipes and policies for fortification, warming, bolus feedings, and assuring correct milk for each baby a. Use only screened pasteurized milk b. Consider strategies to optimize growth in babies receiving donor milk c. Track batch number of milk given to infant Actions: a. Identify one senior administrative leaders briefed, updated and actively supporting the project a. Establish aim (s) b. Review current status of human milk use in the NICU c. Develop methods to communicate project aim and regularly report initiative progress to staff d. Identify methods to collect data on initiation, duration of feedings, exclusivity and patient experience e. Meet as a leadership team monthly to discuss project execution and results a. Consider whether NICU Lactation Consultant staffing is adequate to support nursing staff and mothers b. Offer breastfeeding support groups and peer support for in-patients and c. Refrain from accepting and distributing any infant formula marketing materials

2. NICU Leadership Team

3. Executive and NICU Leadership