East Meets West: Effect of Acupuncture on Lactation and Maternal Quality of Life

Objective: To evaluate the impact of acupuncture as part of a traditional Chinese medicine (TCM) treatment plan on lactation and maternal well-being in pump-dependent mothers of hospitalized neonates during the first 30 days after delivery. Study Design: This single-center study was conducted in a level IV regional neonatal intensive care unit with access to integrative health services. Sixty-six mothers were prospectively enrolled in two nonparallel groups: (1) Standard lactation support and (2) standard lactation support augmented with acupuncture. Daily pump volumes were documented. Participants completed a quality-of-life (QOL) survey at baseline and neonatal day of life 30. A linear model was constructed, adjusting for increased milk production over time. Results: Acupuncture was associated with increased milk production at all time points: Day 10 (p = 0.0002), day 14 (p < 0.0001), day 21 (p < 0.0001), and day 30 (p < 0.0001). Acupuncture was associated with an increase in three of five QOL components: psychological/child's health (p = 0.0006), family/friend relationship (p = 0.0006), and health/functioning (p = 0.02). Conclusion: Mothers receiving acupuncture reported enhanced milk supply and improved QOL. The limited sample size restricts the broad applicability of the results; nonetheless, this study paves the way for further research on the advantages of merging Eastern and Western treatments to enhance human lactation.

Barcode scanning of human milk and enteral formulas improves efficiency and patient safety: A 7-year review

BACKGROUND

Safe handling of human milk (HM) and enteral formulas for patients of all ages is critical in healthcare. Barcode scanning is commonly used to reduce errors. The purpose of this study was to evaluate the impact of barcode scanning for HM and formulas on patient safety.

METHODS

Scanning is used at the time of feeding preparation for HM, facility-prepared formulas, and ready-to-feed enteral formulas for patients of all ages to confirm the feeding matches the provider order, record lot numbers, and ensure expired items are not used. HM feedings are scanned at the time of administration and discharge to ensure the correct milk is being provided to the correct patient. All formulas dispensed as samples to hospital inpatients and outpatients are scanned to record patient and product information in the event of a recall.

RESULTS

Seven-year data showed that scanning has prevented HM misadministration 1226 times. Data for 2 and a half years of fortifier and formula scanning show 480 errors have been prevented. The results show benefits for both patient safety and staff efficiency.

CONCLUSION

The benefits of barcode scanning systems in healthcare are well documented. Beyond the scanning of HM, scanning of fortifiers and formulas can improve patient safety by preventing misadministration for patients of all ages. Systems that offer features such as calculating fortified HM and formula recipes, tracking product lot numbers, and verifying correct products to the provider order can further improve safety as well as efficiency.

A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant

BACKGROUND

Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population.

MATERIALS AND METHODS

A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced.

RESULTS

To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015.

CONCLUSIONS

The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.

Centralized breastmilk handling and bar code scanning improve safety and reduce breastmilk administration errors

Safe handling and preparation of breastmilk within the hospital setting are often taken for granted, and the process may not be scrutinized until problems arise. Areas of concern focus on both risk of contamination of breastmilk feedings due to handling and fortification and risk of a breastmilk misadministration. In two phases, Children's Hospital of Orange County (Orange, CA) implemented centralized breastmilk handling and breastmilk bar code scanning. As a result of these process changes, reports of breastmilk administration errors decreased to zero. However, bar code scanning allowed for the tracking of near misses. During the first 6 months of breastmilk bar code scanning, 55 attempts to feed the wrong breastmilk to the wrong patient and 127 attempts to feed expired breastmilk were prevented. Our findings are consistent with current practice recommendations that support the use of centralized breastmilk handling and systems for proper identification of breastmilk.