369 - Improving Comprehensive Enteral feeding Handling Processes in a level 4 NICU: A Quality Improvement Project

The benefits of human milk are well established for the preterm population. In preterm and some term infants, complex aerodigestive development is necessary prior to attaining the skills of breastfeeding thereby limiting oral feeding skills. In the interim, milk can be offered via enteral feeding tubes. The process of safely attaining human milk includes pumping, labeling, transporting, storing (within appropriate expiration dates), thawing, fortifying and administering to the infant. Safe handling of human milk and enteral formulas for patients, of all ages, within the hospital setting is being recognized as a critical aspect of patient care. Comprehensive enteral feeding handling processes have been employed to optimize patient safety for both pediatric and adult populations.  Data continues to emerge supporting the use of standardized processes, centralized handling with dedicated technicians, and barcode scanning for both safety and efficiency.  Despite published best practices, many hospitals have been unable to gain support to implement programs that meet all recommendations. Challenges in implementation include related knowledge gaps, space constraints, and funding.


Objective:
The objective of this project was to achieve zero errors in labeling, preparation, and administration/discharge of human milk by introducing a standardized comprehensive enteral feeding process with centralized handling by dedicated technicians to mitigate risk of human error.


Design/Methods: Data was collected on current handling processes and medical errors related to human milk handling were reviewed. The first epoch, from 2016-2017, occurred after implementing Electronic Health Record changes and use of a standardized pathway for human milk handling. A second cycle included implementation of a computerized inventory system and documentation of additives. A third cycle included opening of a centralized nutrition center where each feed can be prepared by dedicated technicians using aseptic technique.

Results:
Process auditing began in 2017 and is ongoing.  Compliance for scanning at discharge improved to 100% over the first 3 years with administration scanning compliance at 100% from 2018-2020.  Human milk preparation near misses decreased from an average of 95 per month to an average of 19 per month after implemented centralized handling with dedicated technicians.


Conclusion(s):
In this quality improvement project, creating a comprehensive enteral feeding handling process decreased rates of medical near misses related to human milk handling.