Impact of a standard feeding protocol to decrease time to reach full feeds and central line usage in babies' less than 1500 g: A quality improvement initiative. Issue 2 (April 2023)

• Record Type: Journal Article
• Authors: Sreekumar, Kavita; Baracho, Bonny; Bhoomkar, Nikhil; Joshi, Vaishali
• Is Part Of: Journal of neonatal nursing. Volume 29:Issue 2(2023)
• Page Start: 399
• Page End: 404
• Publication Date: 2023-04
• Subjects: Enteral feeding -- Standard feeding protocol -- Quality improvement -- Neonatologist; Newborn infants -- Care -- Periodicals; Newborn infants -- Diseases -- Periodicals; Neonatal intensive care -- Periodicals; Soins infirmiers en néonatologie -- Périodiques; Infant, Newborn, Diseases -- Periodicals; Intensive Care, Neonatal -- Periodicals; Neonatal Nursing -- Periodicals; 618.9200231
• DOI: 10.1016/j.jnn.2022.06.007
• Languages: English
• ISSNs: 1355-1841

Abstract

Abstract: Background: Feeding the preterm infant is a crucial task for the neonatologist. Early enteral feeding decreases the time to reach full feeding volume, as well as length of stay without increasing Necrotising Enterocolitis (NEC) or serious infections. In our neonatal unit, there was no standard feeding protocol that was being followed. There was a tendency to delay initial feeds with slower advancements, mainly due to fear of NEC. Hence, we decided to conduct this Quality Improvement initiative to standardise the enteral feeding guidelines, decrease time to reach full enteral feeds and secondarily to reduce the utilisation of central lines for infants with a birth weight less than 1.5 kg. Methods: The Quality Improvement (QI) team targeted a goal to decrease time to achieve full enteral feeds from average 13 days to less than 10 days by May 2021 in Very low birth weight (VLBW) infants. All VLBW babies (1–1.5 kgs) irrespective of gestation age were included. A Standard Feeding Protocol was formulated, which was then implemented in the unit in September 2020 as part of the initiative. Time to reach full feeds and central line utilisation were used as the outcome measures. The study was planned in three phases and three major changes ideas were tested. Results: 36 newborns were enrolled retrospectively prior to the initiation of the standard feeding protocol and 48 neonates were enrolled after the feeding protocol was implemented in the NICU. The mean number of days to reach full feeds decreased from 13 days to 9 days and the average number of days with central line in situ decreased from 8.5 days to 5.7 days. Conclusion: Implementation of a Standard feeding protocol promotes early initiation and rapid advancement of enteral feeding, thereby reducing the time to reach full feeds and decreasing central line usage.