title: A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant.
abstract: BACKGROUND
  Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population.
  
  
  METHODS
  A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced.
  
  
  RESULTS
  To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015.
  
  
  CONCLUSIONS
  The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.
authors.affiliation: 1 Division of Neonatology, Children's Hospital of Orange County , Orange, California.|2 Clinical Nutrition and Lactation Services, Children's Hospital of Orange County , Orange, California.
authors.forename: Christine
authors.initials: C
authors.lastname: Bixby
authors.affiliation: 2 Clinical Nutrition and Lactation Services, Children's Hospital of Orange County , Orange, California.
authors.forename: Cindy
authors.initials: C
authors.lastname: Baker-Fox
authors.affiliation: 2 Clinical Nutrition and Lactation Services, Children's Hospital of Orange County , Orange, California.
authors.forename: Crystal
authors.initials: C
authors.lastname: Deming
authors.affiliation: 1 Division of Neonatology, Children's Hospital of Orange County , Orange, California.
authors.forename: Vijay
authors.initials: V
authors.lastname: Dhar
authors.affiliation: 2 Clinical Nutrition and Lactation Services, Children's Hospital of Orange County , Orange, California.
authors.forename: Caroline
authors.initials: C
authors.lastname: Steele
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods*; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007774:Lactation; D008297:Male; D008895:Milk, Human; D009035:Mothers / Q000193:education / Q000523:psychology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015397:Program Evaluation; D058996:Quality Improvement