Got (the Right) Milk? How a Blended Quality Improvement Approach Catalyzed Change.

Area of Science:

• Neonatal care
• Quality improvement science
• Healthcare process optimization

Background:

• Breast milk handling in Neonatal Intensive Care Units (NICUs) involves complex processes: expression, storage, preparation, fortification, and feeding.
• Errors in breast milk administration pose significant risks to the health and well-being of vulnerable infants and their families.

Purpose of the Study:

• To describe the development, implementation, and evaluation of a program aimed at improving infant feeding processes within a NICU setting.
• To systematically enhance the safety and efficiency of human milk and formula dispensation.

Main Methods:

• A blended quality improvement approach was employed, integrating the Model for Improvement, Lean, and Six Sigma methodologies.
• Principles of High Reliability Organizations were utilized to identify and implement short-, medium-, and long-term improvement strategies.
• Multidisciplinary, cross-departmental teams involving diverse stakeholders were convened to ensure comprehensive process examination.

Main Results:

• The implemented program led to a substantial strengthening of the entire milk and formula dispensation system.
• A significant reduction in feeding errors was achieved, with errors decreased by 83%.
• A clear vision and actionable plan for continuous improvement in infant feeding processes were established.

Conclusions:

• A systematic quality improvement approach, utilizing proven methodologies and expert project management, is crucial for optimizing NICU infant feeding processes.
• Engaging multidisciplinary teams with diverse perspectives is essential for identifying risks and developing innovative solutions.
• Adopting reliable, predictable processes, similar to those in pharmacy for medication preparation, including automated verification, is recommended for human milk and formula preparation.