Treating Newborns in the PICU with Oropharyngeal Therapy with Colostrum
AuthorJohnson, Margaret C.
AdvisorConnolly, Mary Ellen
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AbstractProblem: The 19-bed Pediatric Intensive Care Unit (PICU) at a large academic medical center did not include oropharyngeal therapy (OPT) with colostrum or mother's own milk (MOM) as a standard of care for critically ill infants. This is a modality for early human milk introduction recommended by the national authority for the WHO/UNICEF Baby Friendly Hospital Initiative. Chart audits found that documentation of oral care with breastmilk was below 20%. Purpose: This quality improvement project aims to increase the number of critically ill infants who receive OPT with colostrum or MOM in the identified setting. Methods: In-service style education and PowerPoint presentation was disseminated to the PICU care team including MDs, CRNPs, dietitians, as well as nursing staff. Education detailed the importance of the practice change and how to perform OPT safely. Similar information was made available for parents via handouts and visual aids. The multidisciplinary team assisted in the development of guidelines and eligibility criteria including all infants zero days to three months old, who have available mother's milk free from harmful substances. An order for OPT was added to the EHR for all eligible patients. Weekly audits were performed using a VPN-protected software called RED Cap, documenting the number of patients eligible to receive OPT and the number of patients receiving OPT. Data collected by RNs included: date, patient's MRN (that was de-identified), NPO status, milk availability, presence of an order for OPT, and if OPT was performed at least 6 times in the previous 24 hours. Results: There were 41 audit responses over a 15-week period from 16 different patients. 65% of the patients audited received OPT 6 times in 24 hours. Overall OPT compliance increased from 12.5% in the pre-implementation phase to 67% compliance. Conclusions: The goal of 100% compliance was not met but progress was achieved. This quality improvement (QI) project has provided valuable contributions to the setting by increasing the number of infants who received OPT. This QI has created a renewed focus on breastfeeding and its benefits in the critically ill patient population in the identified setting.
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Identifier to cite or link to this itemhttp://hdl.handle.net/10713/20843
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Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International