It is important for our littlest patients in the Neonatal Intensive Care Unit (NICU) to receive human or breastmilk as they grow and develop. With that being said, they have their own unique patient safety needs. Our organization uses technology to ensure that our NICU babies receive human milk safely. What do I mean by that? Please allow me to explain.

The NICU Patients

Ours is a level three NICU. We have patients as young as 23 weeks, weighing barely a pound. Oftentimes, these babies need a lot of assistance in breathing, eating, and other basic functions. On the other hand, we also have full-term newborns who are just there for low blood sugar issues, for example. Yes, they are all neonates, but their nutritional needs are diverse.

We also have to factor in their respective moms’ ability to produce milk for their consumption. Some mothers produce a lot, while others do not. In fact, this is one of the very first discussions that we have had post-delivery. Lucky for us, we have dedicated lactation consultants who really take the time to educate parents regarding breast milk production and breastfeeding.

Lack of Breastmilk

Not everyone produces sufficient milk for their babies. Knowing the utmost importance of breastmilk in the baby’s growth and development, some parents worry because of this. Our organization, fortunately, utilizes donor milk from an accredited local milk bank. The availability of donor milk assures parents that there is a supply to augment their own.

We have two kinds of donor milk: the preterm donor milk and the term donor milk. The baby’s gestational age and nutritional needs determine the correct use. Aside from the kind of donor milk, we also have to look into the caloric requirement of each baby. For some, neonatologists may recommend human milk fortification. This basically means that we have to add a fortifier to increase the caloric content for the same amount of milk. 

For example, an ounce of human milk is between 19 to 20 calories. Upon adding a packet of fortifiers, that ounce of milk now contains 22 calories. Human milk fortification is dependent on what your neonatologist orders based on the baby’s need, of course.

Committing Errors

When preparing milk, you would want to be very careful to prevent making mistakes. A wrong label here, an incorrect amount or fortification there… Those can result in adverse reactions to your patients’ developing bodies.

How Many Bottles/Syringes Do I Prepare?

If you are taking care of critically sick NICU babies, you can have a maximum of two patients. Most sick babies don’t usually eat by mouth. Rather, they receive total parenteral nutrition via the intravenous route. In the interest of this article, we will not be talking about those kinds of NICU patients.

On the other hand, if babies are more stable, a NICU nurse can have 3-4 at an average. They eat every 3-4 hours. So, doing math, you will need to prepare at least 9 to 16 bottles of human milk for your shift.

How Much Time Do I Need to Complete the Preparation?

If you are a very meticulous nurse, this process will take at least 4-5 minutes per bottle. That means that you have to carve out 30-60 minutes of your shift just to prepare those milk for your shift alone. Who has time for that, right? One significant study even concluded that nurses collectively spend as much time as 40 hours/weekly away from their patients just to prepare human milk without technology use.

Workarounds

On the flip side, you can speed things up if you skip a step here or there. This is an example of a workaround.

Simply said, a workaround is not following the recommended workflow to a “T”.

Sure, this can save you time, but at what expense?

Some common errors due to workarounds include mislabeled milk bottles, wrong caloric content, incorrect amount, etc. These mistakes can happen at any point in milk preparation and administration.

Obviously, we want to avoid giving the wrong milk to the wrong baby. It is therefore significant that we find ways to mitigate and prevent these errors from reaching our patients.

Preventing Mistakes from Happening in the NICU

The same study cited above proposed that NICU settings have options to prevent mistakes from happening. The suggestions include hiring a full-time milk technician, having a dedicated milk preparation room, and a positive patient and human milk identification using a bar code scanning tool. Our NICU is fortunate enough to have all of those.

A Full-Time Milk Technician: Is it worth the money?

The short answer is Yes!

Remember the weekly 40 hours that nurses spend away from bedside preparing milk? Having a milk tech will free up those hours for the nurses to be able to do their other tasks. And you know what else? The milk tech’s salary is lower than the nurses’ overtime pay.

The Importance of Having a Milk Preparation Room

Our milk preparation room is dedicated solely for that purpose: milk preparation. It has our human milk refrigerator and freezers. Several human milk warmers are there. Fortifiers, bottles, syringes, computers, scanners, and milk label printers are within reach for convenience and ease of use.   

Nurses, lactation consultants, and milk techs receive, thaw, prepare, fortify, and distribute milk there. Having a human milk preparation room lessens the potential for distraction and making mistakes. The baby’s electronic record is accessed via the available computer. The NICU staff is then able to compare the milk requisition form with the actual doctor’s order.

A Bar Code Scanner? In the NICU?

Why not? Our bar code scanners scan a baby’s identification band, blood, medications, and yes, even breast milk.

Depending on your organization, that bar code scanner may be just to document your breast milk administration in the baby’s electronic health record (EHR). Our bar code scanner is associated with a human milk management system. Long story short, we have an application that keeps track of breast milk.

It follows the “life-cycle” of a milk bottle. The process starts from the time it has been received into the system until it is administered to the baby. It keeps an accurate inventory of the available milk bottles for use. It tracks what happened to a particular bottle if it has been unaccounted for.

From the administrative side of things, leaders can review errors or compliance reports. Data analysis can be drilled down to what mistake was done, by whom, and when. This is very useful when peer coaching is needed after a safety event happens.

However, a stand-alone application has to “communicate” with the EHR for it to be useful in practice. That is what I meant by interoperability between the two applications. My mentor and I worked extensively in making that happen. So far, that interoperability has been seamless since its first Go-Live date in early 2020.

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Our Local Success

Following the implementation of this system, our compliance for receiving the bottles into the system was 100%. Nurses scanned both the correct baby’s ID and the correct bottle at 99.96%. Sadly, our compliance when discharging the bottles was at a dismal 70.43%.

These data signify that work still needs to be done. After all, the health information technology tools are only as good as the efficiency and consistency of their respective usage. Hopefully, I can contribute to the continuous improvement of these results as a NICU subject matter expert and a credentialed trainer for our EHR system.

What about you? What technological tool would you advocate for to improve patient safety and enhance nursing workflow in your own practice? Please share them through the Comments section below so that we can learn from your own experiences.

*Parts of this article were from my submitted paper for our hospital’s Magnet redesignation.

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