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Newborn Care Poster Presentation Purpose for the Program To increase the number of neonatal intensive care unit (NICU) newborns discharged on maternal breast milk (MBM). Pumping to establish and maintain a milk supply requires tremendous dedication. Many NICU mothers pump for weeks or even months before their infants are physically and developmentally ready to attempt oral feedings. In 2009 to 2011 at Winnie Palmer Hospital for Women & Babies, 85% of NICU mothers initiated breast pumping and were still supplying MBM for their infants on day 7 of life. However, by the newborns' discharge, this rate fell to less than 40%. The NICU's Breast is Best Committee implemented a First Feeding at Breast initiative as a nursing measure to improve rates of newborns who received MBM at discharge. Proposed Change As a department, the NICU prioritizes the first oral feeding to be a breast feeding for all NICU infants whose mothers desire to breastfeed. NICU policy states a nipple feeding can be a bottle nipple or a breast feeding. Individual nursing care practice ultimately determines route of initial oral feeding. Implementation, Outcomes, and Evaluation Mothers who were pumping were asked if they would like for their infants' first oral feeding to be a breast feeding. If the mother agreed (and most did), then a small sign was attached to the crib indicating the mother's desire to breastfeed for her newborn's first nipple feeding. This visual cue reminded the mother of her ultimate goal and encouraged staff to support her efforts. When this initiative began, the rate of first feeding at breast was zero and the portion of newborns who received MBM at discharge was approximately 40%. Within 6 months of implementation, the rate of first feed at breast was up to 92% and within this cohort, 92% were discharged on MBM. In contrast, during this same period, the rate of MBM at discharge for newborns whose first oral feeding was not a breast feed was 40% before the initiative and 36% after. Implications for Nursing Practice This nurse-driven initiative essentially costs nothing other than interest and a willingness to alter individual practice routines. The collaboration between the nurse and mother regarding a first oral feeding also highlighted the mother's expanding role in the daily care of her infant. The NICU experience by its very nature robs parents of so many facets of parenting, at least for a time. The First Feeding at Breast initiative returned one big first to the mother.

Paper Presentation Purpose for the Program To improve rates for early initiation of breast pumping among mothers who are separated from their newborns after giving birth at a Baby Friendly–certified hospital. Proposed Change To initiate the Power Hour campaign on the labor and delivery unit using Transforming Care at the Bedside principles. Implementation, Outcomes, and Evaluation Before this initiative, initiation of breast pumping within 6 hours of birth was a mother/infant unit expectation for mothers who were separated from their newborns. Adherence was low and practice among nurses varied. The neonatal intensive care unit (NICU) lactation consultant provided evidence that supported early initiation of breast pumping, especially within the first hour, but this information did not change practice. Labor and delivery nurses who were motivated to support early initiation within the first hour encountered barriers. Breast pumps were stored in central supply, and pump kits were stored on the mother/infant unit. Mothers who pumped more than 6 hours after birth were dismayed at the small volumes of colostrum they were able to express. The Transforming Care at the Bedside team in collaboration with the advanced practice nurse leader took on this opportunity for improvement to provide the best in evidence‐based care to our new mothers. Breast pump kits and pumps are no longer stored in central supply, and par‐level inventory is maintained on the labor and delivery unit. The workflow changed from a multiple step process involving many departments to a single‐step process involving a trip to the storeroom. The time to obtain required supplies decreased from 60 minutes to 10 minutes. New mothers are shown models to demonstrate how small their newborn's stomachs are and to reassure them that they are producing enough colostrum. The process is hard wired into nursing workflow by adding early initiation of breast pumping to the order sets, electronic medical record documentation, and infant feeding guidelines. Audits of the electronic medical record were used to track compliance, and feedback from nurses guided any revisions needed to the new clinical practice. The nurse‐led campaign empowered nurses at the bedside to apply evidence‐based practice in their daily work. Rates of early initiation of breast pumping increased from 1% to 30% at 1 hour within a few months of implementation. Implications for Nursing Practice Nurses at the bedside are experts in identifying opportunities for improvement in patient care and nursing workflow. Given the right tools, guidance, and time off from the unit, bedside nurses can transform care at the bedside to improve patient experience and nursing satisfaction.

The purpose of this study was to identify if special breast cleansing before breast pumping would have an affect on lowering bacterial colony counts of cultured breast milk. Sixty-five women whose infants were being cared for in a NICU and who wished to pump their breasts for future breast milk feedings were randomly assigned to one of two groups: members of a control group were instructed to wash their hands thoroughly before breast pumping, and members of an experimental group were instructed to wash their hands thoroughly and were given special instructions on breast cleansing. All other breast pumping and milk collection instructions for both groups remained the same. A student's t-test revealed a significant difference between the two groups; women who performed special breast cleansing before breast pumping had significantly lower bacterial colony counts in their cultured breast milks.