Continuous quality improvement in a level IIIB NICU to increase human milk use at day of life 14, day of life 28, and discharge

Despite the known benefits of human milk (HM) feedings for high-risk infants, many barriers still remain to providing HM. We implemented a quality improvement (QI) project to increase HM use at 3 time points. All first admissions to the neonatal intensive care unit (NICU) from 2008 to 2012 were included in the dataset. We documented any HM use for infants in our NICU at day of life 14 (DOL14), day of life 28 (DOL28), and discharge. We used run charts to track our progress through the project period and used logistic regression to test for trend, using STATA for data analysis. HM use was explored for all infants and separated out by gestational age (<32 weeks and ≥32 weeks) and by birth weight (very low-birth-weight [VLBW] infants). For all admitted infants, HM use increased from 64.95% to 73.66% at DOL14, from 55.03% to 70.06% at DOL28, and from 31.15% to 36.28% at discharge. For infants who were less than 32 weeks gestation, HM use increased from 67.63% to 82.44% at DOL14, from 57.14% to 80.00% at DOL28, and from 37.93% to 38.58% at discharge. For VLBW infants, HM use increased from 70.73% to 82.08% at DOL14 and from 58.12% to 80.00% at DOL28. After implementation of the QI project, overall HM use has increased. It was noted that documentation of HM use at discharge needed improvement.