Developing a Comprehensive Protocol To Address Human Milk Exposures

Abstract

BACKGROUND: As the prevalence of breastfeeding has increased, more infants are fed pumped breastmilk during hospitalization. Three incidents in which an infant received the wrong human milk were documented from different units of the hospital over the period of 1 year. Because human milk might transmit important viral pathogens (such as HIV), uncertainty existed regarding delegation of duties and appropriate tests to perform during these occurrences. OBJECTIVES: To improve patient safety by developing a post-exposure protocol and review existing policies surrounding the use of human milk. METHODS: After consultation with Risk Management to confirm documented cases, a work group was established. Participants included members of the Children's Hospital of Philadelphia (CHOP) Breastfeeding Committee and the Risk Management and Infection Prevention and Control (IPC) departments. Current policies and procedures regarding the use of human milk were reviewed. Hospital-wide human milk management has been ongoing, and data regarding use across the institution were reviewed. In addition, nurses throughout the institutions were surveyed about the labeling, storage, and administration of human milk. A literature search was conducted to determine best practices. Other institutions were surveyed as to their procedures. RESULTS: 1) Nursing policy was revised; two healthcare providers verify identifying information prior to administration of human milk. 2) A Web-based nursing competency on human milk management was developed and implemented. 3) A post-exposure IPC protocol was developed for use in the event of an occurrence. 4) The CHOP Breastfeeding Committee developed an “exposure packet” that contains post-exposure protocols addressing physician and nursing responsibilities and a parent information sheet. 5) The “exposure packet” was made available to all institutional clinicians through the hospital's intranet. 6) Staff was educated about the protocols and appropriate use of this packet by the membership of the Nursing Clinical Practice Committee. CONCLUSIONS: An interdisciplinary team utilized quality improvement methodologies to revise and improve delivery of human breastmilk to infants. No further incidents have been documented after implementing this protocol.