A Neonatal Dextrose Gel Algorithm to Increase Exclusive Breastfeeding Rates at Discharge

Abstract

Problem & Purpose: Over 80% of newborns nationally are breastfed after birth, yet the exclusive breastfeeding rate of a Women’s Health Services Department was 8%. Formula supplementation of hypoglycemic breastfed babies was identified as a contributing factor to this problem. Evidence demonstrates that using oral dextrose gel to treat neonatal hypoglycemia is safe, efficacious, and can increase breastfeeding rates. The purpose of this project was to implement an oral dextrose gel algorithm for the management of neonatal hypoglycemia to increase exclusive breastfeeding rates at discharge. Goals were to educate 100% of staff nurses on the practice change, administer the gel to 100% of eligible newborns, establish euglycemia in 100% of eligible newborns, and increase exclusive breastfeeding rates at discharge. Methods: A quality improvement project was designed to implement a neonatal dextrose gel algorithm over a 21-week period on a 26-bed mother-baby unit by a team of key stakeholders. In-services and hands-on validations were used to educate staff and the practice change was integrated into the electronic health record system and department policies prior to implementation. The implementation team met weekly to discuss progress and barriers, change champions were used to increase uptake, visual reminders of the algorithm were placed in key areas, and staff huddles were used for continuing education. Results: 95.8% of staff nurses were educated and validated on the practice change, average adherence to the algorithm was 47.2%, and the exclusive breastfeeding rate of newborns at risk for hypoglycemia increased from 17.7% to 18.7% (p=0.9). No babies became hypoglycemic during the implementation phase. Conclusions: Implementing a neonatal dextrose gel algorithm on a mother-baby unit is feasible and can help promote exclusive breastfeeding. Integration into formal unit policies and both new-hire and annual staff competencies is key to sustainability.