Author: Pam Middleton, RN, BSN, MPA
I have been a Nurse Manager in a Level III regional neonatal intensive care unit (NICU) for over 30 years. In 2009, our NICU decided to implement the use of an exclusive human milk diet (EHMD) due to an extremely high rate of necrotizing enterocolitis in our patient population. We were required to create an executive summary report supporting our need for purchasing donor human milk and exclusive human milk-based fortifiers and present our case to the senior leadership executive board. This was an extremely arduous and time-consuming task because we were required to create from scratch most of the documents and workflows to support the decision and move the project forward. In addition to implementing the use of an EHMD, we were also in the process of designing and building a new single-room 24-bed NICU with a formula prep room. I had the privilege to work on both projects.
In the third edition of Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in the Healthcare Facilities,1
the text outlines the best practice in collection, storage, freezing, thawing, mixing, and delivery of human milk. I was amazed at the number of templates this book provides. This edition walks you through how to get started internally with implementing an EHMD diet by “completing a failure mode and effects analysis” (page 233). This stepwise approach identifies all failure points within a process and includes a Risk Priority Number Scoring grid to determine critical potential failure points before starting the project. The book also identifies regulatory requirements and quality indicators such as The Joint Commission’s “Provision of Care” guidelines for enteral feedings. This edition provides an abundant number of sample templates to guide and hasten implementation of using human milk feeding in the NICU. These include an “operational plan for feeding preparation room project,” which provides suggestions on which departments and personnel you may want on your committees. There is also a sample Project Status Report in Section II, which includes key milestones you may want to report on and estimated task completion dates. The text also includes suggestions on determining the size of the milk prep room, inventory of necessary equipment, and supplies that are required for the room. I highly recommend reviewing this book before starting the task on your own. A sample Scope of Service Agreement is also included, along with the Plan-Do-Check-Act Model template which helps you track the progress of each new step implemented. This edition provides many other templates and grids that you can tweak and adapt to make implementing an EHMD diet in your hospital a more efficient, successful, and less stressful process.
Tamyra Rae Hoff, RN, MS, NE-BC
The guidelines provide a very clear blueprint of what the expectations should be for handling human milk while also providing insights into best emerging practices. With the new guidelines, it prepares you for building a future milk lab related to the physical layout, equipment, and staffing. Read more.
Kim Carmignani, MSN, RN-NIC
In chapter 5 of the guidelines, there are specific sections that address the ordering of feeds and the importance of communication between those preparing the milk and the bedside nurse. This communication is “essential to avoid waste and prevent errors.” The guidelines review the risks and benefits of different styles of milk preparation and initiatives that reduce the potential waste of human milk. Read More
Amy Mailand Paradis, NNP
Chapter 7 reviews practices associated with donor milk and donor milk products, along with cautions concerning milk-sharing. Most notable are the various pasteurization techniques used in producing these products. Chapter 11 provides guidance on common clinical issues such as barcode scanning and two-person verification of every container transfer and prior to feeding to avoid administration errors. Read more.