Date of Degree

Fall 2023

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Debbie Conner

Second Advisor

Dr. Melanie Brewer

Abstract

Problem: In a 16-bed neonatal intensive care unit, there was a lack of support for lactating mothers. As infants were admitted, mothers experienced up to a 48-hour delay in lactation support to initiate breastfeeding or pumping.

Aim of the Project: The aim of this project was to ensure lactating parents had adequate support for breastfeeding and pumping to increase human milk at discharge rate. Project interventions aligned with Ohio First Steps for Healthy Babies.

Review of the Evidence: Evidence showed that human milk discharge rates improved with lactation support. Additionally, noted was a significant increase in exclusive breastfeeding, or a combination of breastfeeding and pumping, compared to infants receiving formula. Direct breastfeeding rate improvements were observed for mothers assisted by a certified lactation consultant.

Project Design: A quality improvement project was implemented to improve human milk at discharge rates. The Ohio Health Change model was used to communicate the roles and responsibilities within the key stakeholder group. Three PDSA cycles were completed to test the implemented changes.

Intervention: To educate on the benefits of human milk, initiation, and sustained breastfeeding and pumping, lactation support was provided. Furthermore, a unit-based lactation team was established, meeting with the mother-baby dyad daily upon admission. During admission, mothers were supported to provide milk and prepared to sustain breastfeeding successfully post-discharge. Charge nurses supported project interventions by ensuring breast pumps were at each bedside daily.

Significant Findings/Outcomes: During the project period, human milk discharge rates improved by 7-13% from baseline. While this did not reach the 80% goal, it demonstrated that human milk consumption increased with support. Three process measures evaluated were breast pump compliance, lactation meeting compliance, and overall compliance with mothers providing human milk, which contributed to achieving the project's outcome measure.

Implications for Nursing: Nursing providers strive for effective care. Lactation support meets the Institute for Healthcare Improvement's Triple Aim of improving parents' satisfaction. Educating mothers on human milk benefits and supporting successful breastfeeding is crucial to improving healthcare outcomes for premature infants. This aligns with Six Aims for Healthcare Improvement, including safe, effective, patient-centered care and population health. Within 8 weeks, a unit-based lactation team improved human milk consumption to within 24 hours of discharge.

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