Transitioning to Cue-Based Feeding by Implementing an Evidence-Based Protocol

Abstract

Problem: In an urban 70-bed level IV Neonatal Intensive Care Unit, cue-based feeding scores were previously implemented into the electronic medical record without sufficient education, leading to a lack of documentation by nursing staff. In a random chart audit, only 4% (n=1) of eligible patients had feeding scores documented. As a result, premature infants were not provided developmentally appropriate care that could improve their feeding outcomes. Purpose: The purpose of this quality improvement initiative was to improve the documentation of feeding scores by implementing and evaluating an electronic medical record alert and cue-based feeding rounds to notify providers of cue-based feeding eligibility. Methods: An EMR alert was developed to identify patient eligibility, and cue-based feeding rounds were utilized to notify providers of patients who qualified for cue-based feeding. Eligibility criteria included patients who were 34 weeks corrected gestational age or older, on 4 liters Vapotherm or less, and with a diet order to oral feed. The intent of the alert was to trigger the provider to order feeding score documentation as well as to remind nurses of cue-based feeding assessment and documentation. Results: Forty six percent of staff completed cue-based feeding education (n=105), 100% of eligible patients were identified (N=137), and 27% (n=37) of orders were documented in the EMR. Sixty one percent of eligible patients (n=83) had feeding scores documented. Conclusions: Two hundred forty-two interdisciplinary providers participated in the project. One hundred thirty-seven patients were included in the project. Findings suggest that cue-based feeding rounds can be useful in identifying patients who are eligible for cue-based feeding and reminding staff to document feeding scores. Weekly staff reminders are helpful in identification of eligible infants and in documentation.