Improving Lactation Support: Implementing a Lactation Consult Trigger in a Pediatric Unit

Abstract

Problem: The pediatric care unit (PCU) at a large, urban, academic medical center provides acute care for infants and children, including hospitalized human milk-fed (HMF) infants. The unit lactation rate was low at approximately 25% despite the availability of the lactation department staff to provide support, concerning hospital leaders and stakeholders. Purpose: The purpose of this quality improvement (QI) project was to implement a new, standardized best practice alert (BPA) for lactation consult orders to increase the lactation consult rate for HMF infants under one year of age admitted to the unit. Methods: Baseline data were collected through chart audits assessing patient eligibility, feeding preferences, dietary orders, lactation consult order placement, and documented lactation consults. A BPA was implemented in the electronic health record (EHR) system to prompt nurses to place lactation consult orders based on patient eligibility. All affected team members were educated on their role in activities surrounding the BPA. Weekly chart audits were conducted to evaluate the frequency of lactation orders being placed in response to the BPA prompt alongside the rate of lactation consult completion. Results: The results revealed a high rate of adherence to order placement at 45% after the BPA was implemented. Meanwhile, 60% of the BPA-prompted lactation consults ordered were completed, and a short length of stay was identified as a key limitation to reaching this outcome goal. Overall, 30% of all eligible patients received a lactation consultation from a BPA-prompted order. Conclusions: Implementation of a BPA intervention increases lactation consultation order placement and completed consults, which may improve breastfeeding outcomes for hospitalized HMF infants. Pediatric APRNs can implement BPA initiatives to improve lactation consult rates and affect other desired outcomes.