Got (the Right) Milk? How a Blended Quality Improvement Approach Catalyzed Change

Abstract

As in the realm of pharmacy, the processes involved in preparing feedings for critically ill infants should be carried out via predictable, reliable means including robust automated verification that integrates seamlessly into existing processes. The use of systems employed in pharmacy for medication preparation should be considered in the human milk and formula preparation setting.

The sustainability of Lean in pediatric healthcare: a realist review

“…Of the 11 included documents, six were published primary research studies [ 42 , 43 , 45 , 47 – 49 ], two were published quality improvement case studies [ 44 , 46 ], and three were unpublished quality improvement case reports [ 50 – 52 ] found from our citation searching [ 51 ] and gray literature searching [ 50 , 52 ] (Table 1 ). Of the 11 documents, seven used Lean exclusively [ 44 , 45 , 48 – 52 ]; two used Lean and Six Sigma [ 42 , 43 ]; one used a combination of Lean, Six Sigma, and the Institute for Healthcare Improvement (IHI) Model for Improvement [ 46 ]; and another used Lean with “other” QI classic methods [ 47 ]. Improvements were targeted at the meso (e.g., unit or organization level) ( n = 8) [ 42 – 49 ] and macro (e.g., policy, system) ( n = 3) [ 50 – 52 ] levels of the healthcare system.…”

“…No improvement targeted the individual, micro level. Documents focused on a variety of problems, clinical ( n = 1) [ 42 ], process ( n = 2) [ 43 , 48 ], clinical and process (n = 1) [ 46 ], or process and system problems ( n = 7) [ 44 , 45 , 47 , 49 – 52 ].…”

“… Pediatric eye clinic (micro). Luton, 2015, [ 46 ] Commentary/descriptive No mention at all Lean, Six Sigma, IHI Model for Improvement, clinical and process To describe how a program to prevent feeding errors was developed, implemented, and evaluated. Multi-disciplinary team, QI project manager, executive task force support (leaders).…”

"Quality improvement initiatives in neonatal intensive care unit (NICU) for improved care outcomes- a review of evidence"

“…Infants fed with mother's milk are also less prone to develop metabolic syndrome, low BP, or fewer LDL levels in the later stages of their life. 42 Luton et al, 43 have demonstrated a 83% reduction in the errors associated with feeding the preterm infants in NICU through a proven quality improvement initiative. The expression of human milk and its storage and fortification in this NICU was carefully monitored by the quality improvement team to avoid feeding errors.…”

“…Luton et al 43 Breast milk nutrition Expression of human milk, its storage and fortification in this NICU were carefully monitored Reduction in the human milk errors Meier et al 44 Oza-Frank et al 45 Liu et al, 46 Boyd et al, 47 Cristofalo et al 48…”