Improving Early Colostrum Administration to Very Low Birth Weight Infants in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative

Abstract

To increase early oral immune therapy (OIT) with colostrum administered to the buccal mucosa in order to improve our human milk practices for very low birth weight (VLBW) infants admitted to a level 3 NICU. Using the Institute for Healthcare Improvement's (IHI) Model for Improvement, several interventions aimed at increasing early OIT administration were implemented. Four key drivers included: optimizing evidence based OIT guidelines, personnel alignment and engagement, optimal electronic health record (EHR) use for ordering practices, and timely lactation consultant involvement. The primary outcome measure was early OIT administration, while secondary outcome measures examined all OIT administration and human milk at discharge. Process measures included the percentage of staff members who were compliant with OIT protocol. Early OIT administration increased from a baseline mean of 6% to 55% in the 12-month study period. Percentage of total (early and late) OIT administration to VLBW infants increased from a baseline of 21% to 85%. Average human milk at discharge for VLBW infants remained at 44%, without significant improvement. A multidisciplinary quality improvement initiative led to significant improvement in OIT administration to infants at a level 3 NICU.