Use of the Lean Process to Increase the Number of Mothers Who Pump Breast Milk Within 6 Hours of Birth for Newborns Who Require NICU Care

Abstract

In a tertiary center with 3,600 births annually, data in January 2018 revealed that 20% of breastfeeding mothers with babies in NICU were pumping within 6 hr of birth. The Lean Project was developed to improve time to first pump, use of hand expression, and consistency of pump teaching in the early postpartum period. Hartford Healthcare adopted the Lean Management Process in 2017. Lean uncovers opportunities in quality, builds a culture of accountability, and uses visual cues and the plan–do–study–act (PDSA) cycle to standardize process. This project included chart audits, root cause analysis (RCA) using Pareto charts, prioritization, countermeasure development, identified drivers (expected outcomes), and daily huddles to guide staff. In January, RCA showed that there were insufficient pumps–kits in the labor and delivery unit and that staff did not prioritize pumping for babies in the NICU. A Lean driver was developed with the goal of having 80% of mothers with babies in the NICU pumping breastmilk within 6 hr of delivery. In February, staff education was completed, pumps–kits were added, and the early pumping driver was discussed daily. A PDSA cycle was completed monthly of all NICU transfers for pumping, followed by RCA of trends and countermeasures. Data from February, March, and April demonstrated improvements of 50%, 62%, and 74%, respectively. Development of maternal and newborn exclusion criteria clarified documentation of pumping delays. This success led to the retirement of the pumping driver on the labor and delivery unit and a 2-month decline, to 48% and 50%, in May and June, respectively. After the pumping driver was reimplemented, increases were quickly realized, with 77% and 92% for July and August, respectively. Use of the Lean process has built a culture of accountability to standardize early breast pumping. Consistency and reminders are required to make practice changes into standard work. Future projects include formalizing this practice, adding other best practices, and adopting an accountability process to sustain the gains that have been made.