Incorporating Inpatient Prenatal Lactation Consultation to Promote Informed Decision-making on the Use of Human Milk at a High-risk Delivery Hospital

Purpose/Objectives: The American Academy of Pediatrics recommends use of human milk in the NICU to improve neurodevelopmental outcomes and reduce complications due to prematurity. Expectant families benefit from prenatal lactation consultation to facilitate informed decision-making regarding human milk use. Targeted quality improvement interventions lead to increased rates of inpatient prenatal lactation consultations. The SMART aims for this project included (1) increasing inpatient prenatal lactation consultation ordering by the NICU consultation team to 90% and (2) increasing inpatient prenatal lactation consultation completion to 75% from November 2020–April 2021. Association between inpatient prenatal lactation consult and use of any human milk at the time of discharge was also assessed.

Design/Methods: Our multidisciplinary team derived project aims and a key driver diagram with the global aim of increasing the proportion of NICU patients discharged on any human milk. Interventions focused on promoting the completion of inpatient prenatal lactation consultations by incorporating inpatient prenatal lactation consultation ordering into the NICU consultation team workflow. Inpatient prenatal lactation ordering and prenatal lactation completion data were collected prospectively via daily electronic medical record chart audits. Team members met monthly to analyze run charts and complete PDSA cycles. Education of project goals, standardization of prenatal lactation ordering via auto-text in NICU team prenatal consultation documentation, targeted email reminders, and signage in high-workflow areas integrated prenatal lactation ordering into the NICU workflow. Completing inpatient prenatal lactation consults was facilitated by collaborating with the lactation team on the interventions, increased assessment of the daily task list, and standardization of prenatal lactation consultation documentation. This project was performed in an academic, baby-friendly, high-risk delivery hospital with a Level III NICU. Fisher’s exact test was used to assess statistical significance between inpatient prenatal lactation consultation and the use of any human milk at the time of discharge.

Results: The six-month pre-intervention baseline rate of inpatient prenatal lactation consults was negligible ( <1%). Using continuous quality improvement, inpatient prenatal lactation ordering increased to 90% over six months (Figure). After the six-month intervention period, 61.5% of prenatal lactation consults ordered were completed (Figure). The proportion of human milk use at discharge was higher in neonates in which expectant families received inpatient prenatal lactation consultation versus those families that did not, 56% vs. 44%, respectively. However, these results were not statistically significant (p=0.36).

Conclusion/Discussion: We achieved our SMART aim for prenatal lactation consultation ordering but not for prenatal lactation completion. However, prenatal lactation consultation completion increased substantially from approximately 0% to ~60% over six months. Common reasons prenatal lactation consultations were incomplete included babies were born or expectant parents were discharged before lactation consults met families. Future opportunities for informed decision-making include parental education materials and increasing prenatal lactation workforce personnel.