Abstract:
Context: This project took place in a 25-bed Mother-Baby Unit and a 56-bed Level 3 Neonatal Intensive Care Unit in North Carolina, aimed at addressing the specialized care needs of late preterm infants (LPIs) through a statewide collaboration focused on quality improvement. A multidisciplinary team collaborated to create comprehensive guidelines for the care of LPIs.
Problem Statement: LPIs, defined as infants born between 34 and 36 weeks of gestation, often face unique developmental challenges that complicate feeding practices. Common issues include delayed lactation onset, respiratory difficulties, hypoglycemia, and coordination problems with suck, swallow, and breath. Routine audits indicated that a significant number of LPIs experience weight loss in their first week of life, leading to increased readmission rates. Specifically, 17% of LPIs were readmitted within 30 days post-discharge, highlighting an urgent need for improved feeding protocols.
Aim Statement: This quality improvement initiative aims to enhance adherence to a newly established standardized feeding and supplementation protocol, increasing compliance from 0% to 75% by December 2024. The goal is to minimize weight loss prior to discharge, thereby reducing the risk of readmission.
Assessment and Analysis: A comprehensive review of data from approximately four hundred LPIs revealed concerning trends: 33% were discharged before 48 hours of life, and 17% experienced weight loss exceeding 7% at discharge. While 66% were breastfeeding at discharge, gaps in feeding support were evident. Based on this analysis, the team developed an aim and key driver diagram (KDD) to guide interventions. See attached KDD.
Intervention: In response to the identified inconsistencies in feeding practices, a standardized feeding protocol was developed. This protocol emphasizes immediate breastfeeding attempts, early initiation of pumping, and daily lactation consultant assessments. It includes specific feeding strategies, such as providing supplementation if weight loss surpasses established thresholds. See attached Feeding Algorithm.
Strategy for Change: Implementation commenced in January 2024, with data entry and extraction into a statewide database over the next 11 months. The protocol underwent approval from leadership councils and was presented to staff through webinars and meetings, officially launching in August 2024. Early feedback mechanisms are planned for December 2024.
Measures of Improvement: The project's effectiveness will be tracked through monthly audits measuring key outcomes, including readmission rates, breastfeeding attempts, feeding supplementation, weight monitoring, and timely pediatric follow-ups. Initial data indicates promising trends, such as no readmissions within 30 days of discharge and a notable decrease in weight loss exceeding 7% at discharge. See attached Run Charts.
Family Champions Involvement: The inclusion of a family champion—who has personal experience as a parent of an LPI—has provided valuable insights and fostered a family-centered approach to protocol development.
Effects of Change: Preliminary outcomes suggest that adherence to standardized feeding protocols significantly enhances LPI health and decreases readmission rates. These findings underscore the necessity of structured feeding strategies in clinical practice, promoting better growth, health outcomes, and family satisfaction.
Lessons Learned: Key insights from the project emphasize the importance of early multidisciplinary engagement, continuous staff education, and ongoing assessment of the protocol’s effectiveness. Maintaining transparent communication with all stakeholders fosters commitment and enthusiasm for the project.
Recommendations for Practice: To further improve outcomes for LPIs, ongoing staff education, regular audits of feeding practices, and continuous protocol refinement based on data-driven insights are recommended. Prioritizing evidence-based feeding strategies will enhance the quality of care provided to late preterm infants.
