Purpose for the Program
Breastfeeding promotes the mother–infant relationship and provides the best nutritional support for the infant. For infants born with medical needs who require admission to the nursery or neonatal intensive care unit, breast milk may be expressed and stored until the time of administration. The Northern Westchester Neonatal Intensive Care Unit/Nursery Nursing Shared Governance Council identified an opportunity to improve practice and meet quality standards to decrease the potential for administration errors.
To replace handwritten labels for identification of stored expressed breast milk, which have to be verified by two nurses, with electronically scanned bar-coded labels. Utilizing the existing electronic medical records system in an adaptive manner provided increased time for the delivery of patient care.
Implementation, Outcomes, and Evaluation
Through an interdisciplinary approach, a process was developed to incorporate aspects of medication administration and bar-coded label use to improve the efficacy of stored expressed breast milk administration. A workflow algorithm defines the system's steps and user accountabilities. A physician's order initiates the process and generates the first bar-coded expressed breast milk label. Parental involvement is essential to the appropriate identification of stored expressed breast milk. The parent receives the bar-coded labels from the nurse after the two patient identifiers, name and date of birth, are verified. It is the responsibility of the parent to label each expressed breast milk container with a bar-coded label and date and time of pumping. The nurse is accountable for scanning the expressed breast milk into the electronic medication record at the bedside.
A corresponding policy was approved and distributed, and a staff competency tool was completed prior to implementation of the new process. The process was well received. An initial audit of stored expressed breast milk administration over 4 weeks indicated 92% adherence to the process. The adherence goal for this initiative is 100%. The staff has been provided with ongoing education and support, and the unit has remained error free. The Nursing Shared Governance Council is reviewing expressed breast milk warming practices to further enhance management of expressed breast milk.
Implications for Nursing Practice
Neonatal nurses are strong advocates for the smallest of patients. The implementation of the electronic bar-coded label process in expressed breast milk management supports practice change to improve the quality of infant care, increase parental confidence, and secure patient safety. The use of this technological advancement can be applied to other instances of body fluid verification, such as blood administrations, to prevent errors.