The 17 units in the East of England Perinatal Network, introduced a quality improvement intervention ‘care bundle’ aimed at increasing use of maternal breast milk (MBM) and reducing variation in enteral feeding practices. The bundle consisted of four elements: early promotion of expression and use of MBM, ongoing support to provide breast milk throughout the neonatal journey, a standardised enteral feeding guideline and an aseptic non-touch technique for milk preparation.Methods
The care bundle was implemented in January 2011 following a training programme supported by learning tools, posters and audit materials. Champions disseminated and led the improvements in their own units which included midwives, neonatologists, surgeons and lactation specialists. Monthly audits of compliance were undertaken and Plan-Do-Study-Act cycles of change were used to improve and refine practice. Regular newsletters communicated progress with the changes.Results
90% compliance with all elements of the bundle was achieved across the network within the first eight months of implementation. Over the 4 year evaluation period, exclusive MBM at discharge in the EoE improved significantly faster than in the rest of the country. In the EoE the percentage of care days where babies received MBM was in decline prior to implementation of the bundle, however, there was a significant improvement in trend from pre to post introduction of the bundle.Conclusions
Compliance audits demonstrated that it is possible to standardise feeding practices across a network. Quality improvement projects benefit from a structured model for improvement, transparent measurement and feedback and a collaborative multidisciplinary approach.