Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan.
Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing and Nurse Scientist for the Lactation Program at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Breastfeed Med. 2020 Aug;15(8):538-545. doi: 10.1089/bfm.2019.0298. Epub 2020 Jul 14.
The leadership team at the Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University in Tokyo, Japan sought to improve our human milk (HM) and breastfeeding rates for vulnerable infants. This article describes the quality improvement (QI) initiative, which involved the implementation of the first three steps of the Spatz 10-step model for HM and breastfeeding in vulnerable infants. Our main objectives were to ensure that: (1) families were making informed feeding decisions about HM and breastfeeding as a medical intervention; (2) mothers were pumping early and often; (3) the staff implemented HM management; and (4) the proportion of infants who received HM at 1 month of life increased. Using a QI approach led by a nursing team, we were able to achieve all our goals. Our prenatal education was effective at having more families choose HM and breastfeeding versus formula. Our time to first milk expression improved as did the mothers' adherence with pumping early and often. We purchased physical resources to ensure that all milk was efficiently delivered to the infant in appropriate storage containers. At the initiation of this QI project, exclusive HM rates at discharge were only 15%. In only a 4 months time frame, the HM rate at discharge increased threefold to 47%. During the entire year, the portion of mothers selecting formula continued to decrease and HM rates continued to rise.
日本东京埼玉医科大学埼玉医疗中心母婴胎儿新生儿医学中心的领导团队希望提高我们为脆弱婴儿提供人乳（HM）和母乳喂养的比率。本文介绍了质量改进（QI）计划，该计划涉及在脆弱婴儿的 HM 和母乳喂养中实施 Spatz 10 步模型的前三个步骤。我们的主要目标是确保：（1）家庭能够就 HM 和母乳喂养作为医疗干预做出明智的喂养决策；（2）母亲尽早且频繁地泵奶；（3）工作人员实施 HM 管理；（4）在 1 个月大时接受 HM 的婴儿比例增加。通过由护理团队领导的 QI 方法，我们实现了所有目标。我们的产前教育非常有效，使更多家庭选择 HM 和母乳喂养而不是配方奶。我们的首次挤奶时间得到了改善，母亲们也更早且更频繁地进行了泵奶。我们购买了实物资源，以确保所有母乳都能以适当的储存容器高效地输送给婴儿。在这个 QI 项目开始时，出院时的纯 HM 率仅为 15%。仅仅在 4 个月的时间内，出院时的 HM 率就增加了两倍，达到了 47%。在整个一年中，选择配方奶的母亲比例继续下降，HM 率继续上升。
