Department of Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
Department of Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, India
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001467.
Feed intolerance and necrotising enterocolitis (NEC) are challenges while treating sick neonates. These can be reduced by giving human milk, but adequate availability of mother's own milk or pasteurised donor human milk (PDHM) is a challenge in neonatal setups, like ours, without an attached human milk bank. Hence, this quality improvement initiative was taken to improve donor human milk collection in our urban tertiary-care teaching hospital, to at least 500 mL per week in 4 weeks. After analysing the problem, our quality improvement team identified a shortage of human milk donation that was due to low awareness among the stakeholders and lack of a system to collect and store human milk and transport it to a milk bank. The team first established a system of supplies needed for milk collection, storage and transportation. It then tested change idea of information, education and counselling to increase milk donation. The team carried out a few plan-do-study-act cycles (individual and group counsellings, and usage of videos and information leaflets) to test the change ideas and adapted a few and abandoned some. During this journey, the milk collection increased to above the target amount. Various challenges were addressed, and there was a need for constant motivation of the stakeholders, especially the mothers, and now there is sustained milk donation in the setup. This is incorporated in the standard operating procedure and as a quality indicator of the unit for sustaining the changes in the unit. Our initiative can be replicated in other setups for increasing collection of donor human milk. Greater PDHM availability for sick neonates will, in effect, reduce NEC and feeding intolerance rates, leading to reduced hospital stay, morbidity, mortality and economic burden.
在治疗患病新生儿时，喂养不耐受和坏死性小肠结肠炎（NEC）是挑战。通过给予人乳可以减少这些问题，但在我们这样没有附属人乳库的新生儿设置中，母亲自己的人乳或巴氏消毒供体人乳（PDHM）的充足供应是一个挑战。因此，我们采取了这项质量改进措施，以提高我们的城市三级保健教学医院的供体人乳收集量，在 4 周内每周至少收集 500 毫升。在分析问题后，我们的质量改进团队发现供体人乳捐赠不足，这是由于利益相关者的意识低下以及缺乏收集、储存和运输人乳到奶库的系统。团队首先建立了收集、储存和运输所需的供应品系统。然后，它测试了信息、教育和咨询的变更想法，以增加人乳捐赠。团队进行了几个计划-执行-研究-行动循环（个人和小组咨询，以及使用视频和信息传单）来测试变更想法，并适应了一些并放弃了一些。在这个过程中，人乳收集量增加到了目标以上。解决了各种挑战，需要不断激励利益相关者，特别是母亲，现在该设置中持续有人乳捐赠。这已纳入标准操作程序，并作为该单位的质量指标，以维持单位的变更。我们的倡议可以在其他设置中复制，以增加供体人乳的收集量。更多 PDHM 的可用性将有效降低 NEC 和喂养不耐受率，从而减少住院时间、发病率、死亡率和经济负担。
