Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital

Abstract

Feed intolerance and necrotising enterocolitis (NEC) are challenges while treating sick neonates. These can be reduced by giving human milk, but adequate availability of mother’s own milk or pasteurised donor human milk (PDHM) is a challenge in neonatal setups, like ours, without an attached human milk bank. Hence, this quality improvement initiative was taken to improve donor human milk collection in our urban tertiary-care teaching hospital, to at least 500 mL per week in 4 weeks. After analysing the problem, our quality improvement team identified a shortage of human milk donation that was due to low awareness among the stakeholders and lack of a system to collect and store human milk and transport it to a milk bank. The team first established a system of supplies needed for milk collection, storage and transportation. It then tested change idea of information, education and counselling to increase milk donation. The team carried out a few plan-do-study-act cycles (individual and group counsellings, and usage of videos and information leaflets) to test the change ideas and adapted a few and abandoned some. During this journey, the milk collection increased to above the target amount. Various challenges were addressed, and there was a need for constant motivation of the stakeholders, especially the mothers, and now there is sustained milk donation in the setup. This is incorporated in the standard operating procedure and as a quality indicator of the unit for sustaining the changes in the unit. Our initiative can be replicated in other setups for increasing collection of donor human milk. Greater PDHM availability for sick neonates will, in effect, reduce NEC and feeding intolerance rates, leading to reduced hospital stay, morbidity, mortality and economic burden.

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

“…These include reduced late-onset neonatal sepsis rates, 15 improved adherence to infection control practices 16 and enhanced team communication and collaboration across various health facilities. Other outcomes which have been reported and published in contemporary literature by members of the CoP are increasing adherence to the use of e-partograph, 17 improving donor human milk collection, 18 development of an antibiotic stewardship programme, 19 use of sucrose analgesia in NICU 20 and pre-identification of high-risk pregnancies. 21 These outcomes not only demonstrate the potential of the dCoP platform to drive meaningful change in clinical practice but also highlight the importance of nurturing a culture of continuous learning and improvement among healthcare professionals.…”

“…Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach 16 Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital 18 Quality improvement in Kangaroo Mother Care: learning from a teaching hospital 26 Implementing use of sucrose analgesia in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology 20…”