Running head: QUALITY IMPROVEMENT 1

Quality Improvement: Human Donor Milk

Kaitlin Evans

Bon Secours Memorial College of Nursing

March 29, 2017

Professional Role Development - NUR4144

I Pledge
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Quality Improvement Project

A recent quality improvement (QI) project in the neonatal intensive care unit (NICU) at

St. Marys Hospital was performed. Part of the NICU teams job is to care for babies as young as

24 weeks gestation and of very low birth weight (VLBW). With extensive research, help from QI

representatives, and nursing staff, the implementation of donor milk in the NICU was put into

effect. According to EidelmanandSchanler (2012), human milk significantly decreases: hospital

readmissions, necrotizing enterocolitis (NEC), mortality rates, long-term growth failure,

neurodevelopmental delays, retinopathy, and metabolic syndrome (p. 831). Due to an increase of

NEC in the NICU, a collaborative team of nurses, providers, dietician, lactation consultants, and

administration was formed to implement donor human milk in the Bon Secours Richmond

facilities. From a leaders perspective there were barriers to overcome in order to reap the

benefits of providing human donor milk to pre-term infants in the NICU. The four domains of

leadership and the five practices of exemplary leadership were utilized to carry out the

accomplishment of offering donor breast milk to pre-term, low birth weight infants in Bon

Secours Richmond NICUs.

Domains of Leadership

Blanchard and Hodges (2008) describe the four domains of leadership: heart, head,

hands, and habit. In following from our greatest leader, Jesus, a leadership model was born and

servant leadership had a purpose, to serve rather than be served (Blanchard & Hodges, 2008,

p.4). In order for the implementation of donor human milk in the NICU to be a success, the

leaders needed to possess a desire to serve the patients, families, and staff in the NICU. Using

the four domains of leadership barriers were broken improvements were made.

Heart
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As a nurse manager and QI representative the leadership started with the heart. For this

QI project specifically the leadership was modeled on the act of serving pre-term low birth

weight infants. The leaders were not thinking of themselves but those who would be impacted.

The motivation and intent was for better health outcomes of NICU patients and to decrease the

incidences of NEC.

Head

The head looks at the leaders belief and theories about leading and motivating people, in

this case the staff and administration (Blanchard & Hodges, 2008, p.32). The leaders belief in

implementing donor human milk in the NICU was to improve the outcomes of critically ill

infants. The leaders came up with a vision for the NICU; obtaining human donor milk from the

Virginia Milk Bank at The Childrens Hospital of Kings Daughters and administering it to

patients without mothers breast milk, less than 30 weeks, and under 1500 grams. The leaders

worked on empowering staff with education from evidence based practice research. The

manager respected and valued feedback from staff and administration, and took their concerns

into consideration before finalizing the donor human milk policies and procedures.

Hands

Blanchard and Hodges (2008), explain the hands are what others observe about the

leaders behavior and performance (p. 31). The unit manager and QI representatives (leaders)

needed to be vigilant in educating staff and collaborating with other interdisciplinary personal.

This showed their servant leadership focus was not on themselves but on the greater good of the

NICU patients. The leaders recognized the need, acknowledged others input, and corrected them

when mistaken. Staff and administration saw the investment of their leaders and became
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involved in fulfilling the goal of administering human donor milk in Bon Secours Richmond

NICUs.

Habits

Habits are what keep the leader centered, focused on the purpose, and away from

negativity (Blanchard and Hodges, 2008, p.154). To the leader of the NICU and QI

representatives, this could be difficult. People always want to resist change and find areas of

weakness. The leaders in this case were able to overcome by surrounding themselves with the

right relationships, solitude, and prayer. By applying these habits the leaders were able to

counter the negativity and be effective servant leaders.

Practices of Exemplary Leadership

The five practices of exemplary leadership include: modeling the way, inspiring a shared

vision, challenging the process, enabling others to act, and encouraging the heart. To be a leader

in the NICU and implement new policies and procedures, one must embody respect and model a

behavior others want to follow. The leader will inspire staff to look for improvements and help

cultivate shared visions. By challenging the process and seeking out new opportunities for the

staff and unit as a whole, the leader enables others to want to act on change. Nurturing the

collaboration of interdisciplinary teams and staff members strengthens the power of the unit as a

whole, leading back to modeling a way. The NICU leader will recognize the contributions and

hard work of their staff with rewarding and celebrating their accomplishments. The act of a

leader encouraging the heart will improve both staff and patient satisfaction.

Model the Way

The NICU manager and QI representatives were the leaders in implementing human

donor milk in the NICU. The leaders practiced modeling the way by sharing their values and
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visions for the providing pre-term low birth weight infants with a fighting chance. They

advocated for the infants and showed evidence based practice to prove the needs for the infants

in the NICU. Modeling the way, the leaders showed nursing staff, administrators, and physicians

their vision and intent on improving the care and outcomes for the infants.

Inspire a Shared Vision

Starting with the NICU Unit Based Council, leaders presented the evidence of human

donor milk improving pre-term infants outcomes and more specifically the problems with NEC.

Leaders expressed a vision for future advancements in the care offered at Bon Secours Richmond

NICUs. The vision included people from nursing staff, dietary, lactation, administration, and the

Virginia Milk Bank at The Childrens Hospital of the Kings Daughters. The NICU staff felt the

passion from the leaders; people volunteered their time to tour the milk bank and take courses

with dietary to better their knowledge and understanding.

Challenge the Process

The NICU manager and QI representatives (leaders) had to challenge the process. Never

before was human donor milk offered in the Bon Secours Richmond NICUs. Formulas and the

use of pharmacological modalities was the only thing available if the mother was not producing

milk. The increase in NEC made it an urgency to find a nutritional solution for treating the very

low birth weight preterm infants. Leaders researched resolutions and discovered human donor

milk and a milk bank less than three hours from Richmond. Obstacles to overcome were: costs

(milk, freezer to store milk, transport of milk), space (limited space in NICU, no designated milk

prep area), legal matters (consent, protocol, policies), and logistics (tracking shipments, record of

patients who received what milk, labeling, etc.) The leaders considered all the barriers and
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benefits donor human milk would offer the vulnerable patients, and continued to take the risk of

implementing donor human milk in the NICU.

Enable Others to Act

The leaders implemented donor human milk in the NICU by fostering the collaboration

from many different interdisciplinary team members and staff. Dietary, lactation, nursing,

medical providers, and administration played a vital role in making the QI project a success. The

leaders created a trusting team who all shared the same goal of improving pre-term infants

outcomes. By enabling a team to act together under one vision, they were able to develop a

protocol, policy, education sheet for parents and staff, consent form, and a logbook for inventory

(McInnis, Lawmaster, & Smith, 2014).

Encourage the Heart

The leaders exemplary leadership was rounded out with recognition of all who helped

bring donor human milk to the NICU. Milk and cookies was offered to staff, when the first

shipment of human donor milk arrived at St.Marys NICU. During huddles, individual staff

members were recognized for their hard work and bringing the vision to reality. To the leaders it

was important to celebrate the victory of the NICUs accomplishment and commitment to

improving care.

Professional Practice Implications

The leadership for this particular QI project encompassed the four domains of leadership

and the five practices of exemplary leadership. Had the leaders not utilized these domains and

practices, the implementation of human donor milk in the NICU would not have been a success.

The nursing team members were able to visualize the goal, work with a trusted group, share

concerns and recommendations, and were acknowledged for their hard work. The involvement
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of nursing staff and interdisciplinary teams allowed for best practices to be implemented and

barriers overcome.

Outcomes Evaluation

The leaders reached out to sponsors for funds to purchase a commercial refrigerator and

freezer to store the donor human milk. Collaboration between the NICU and Newborn Nursery

at St.Marys allowed for space constraints to be resolved. Leaders led in educating nursing staff

and patient care technicians on how to properly prepare the donor milk and track inventory. The

unit manager worked with risk and legal to develop a contract with The Childrens Hospital of

Kings Daughters Milk Bank (McInnis et al., 2014).

Research suggests that by implementing human donor milk to the very low birth weight

infants, infection rates decrease, eye and brain development will improve, risk of NEC will

decrease, infants will be able to better digest the nutrition, and help the infants will have a better

growth curve (Hair et al., 2016). The involvement of professional practice and servant leadership

has resulted in over twenty-four infants being treated with human donor milk and a decrease in

NEC (McInnis et al., 2014). The leadership utilized to complete the QI project resulted in a

more educated nursing staff, new relationships among interdisciplinary teams, and improved

patient outcomes.
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References

Blanchard,K.H.,&Hodges,P.(2008).LeadlikeJesus:lessonsforeveryonefromthegreatest

leadershiprolemodelofalltime.Nashville,TN:ThomasNelson.

Eidelman,A.I.,MD,&Schanler,R.J.,MD.(2012).BreastfeedingandtheUseofHumanMilk.

Pediatrics:OfficialJournaloftheAmericanAcademyofPediatrics,129(3),827841.

doi:10.1542/peds.20113552

Hair, A. B., Peluso, A. M., Hawthorne, K. M., Perez, J., Smith, D. P., Khan, J. Y., & ... Abrams,

S. A. (2016). Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an

Exclusive Human Milk-Based Diet. Breastfeeding Medicine, 1170-74.

doi:10.1089/bfm.2015.0134

McInnis, B., Lawmaster, S., & Smith, D. (2014). Implementation of donor human milk in a

neonatal intensive care unit. Unpublished manuscript, Womens and Childrens Services,

Bon Secours St.Marys Hospital, Richmond, Virginia.