245 - Creating an Infant-Driven Feeding Protocol in a Level IV NICU: A QI Initiative

Poster Board #: 245
Publication #: 2912-HP-QA.245

Background: Early oral feeding has been shown to provide advantages for preterm infants, such as shortened NICU length of stay and increased weight gain. Despite preterm infants having the required suck-swallow reflexes for oral feeding at 32-34 weeks postmenstrual age, many are not assessed during this time period and may start oral feeding later than necessary due to the lack of a protocol regarding oral feeding assessments in the RBC NICU.


Objective: The global aim is to improve cue-based oral feeding in the RBC NICU. The specific aim was to increase the percentage of infants born under 32 week gestational age and 1500 grams who are assessed with the Oral Feeding Assessment (cue-based screening tool) to 60% by September 2020.


Design/Methods: The Model for Improvement was used with multiple plan-do-study-act (PDSA cycles). Baseline data was collected on babies admitted to the NICU with birth weight of 1500 grams or less and born under 32 weeks gestational age from July of 2019 through April of 2020, including gestational age, birth weight, completion of the Oral Feeding Assessment, and postmenstrual ages at first oral feed and full oral feeds. Interventions have included: electronic medical record reminders to alert the care team when a baby is nearing 32 weeks postmenstrual age to assess for PO feeding readiness; training for NICU nurses on an Infant Driven Feeding protocol for assessing oral feeding cues and scoring feeding quality; and creation of a flowsheet protocol for initiation of oral feeding for preterm infants in the NICU.


Results: Baseline data from 113 infants were included. A total of 178 patients were included and gestational age at birth ranged from 22 0/7 to 37 2/7. The percentage of babies who were assessed with the Oral Feeding Assessment tool at baseline was 27%. Mean postmenstrual age at first oral feed was 34 5/7, and at full oral feeds was 37 1/7. Following interventions, the percentage of babies assessed increased to 61%, above our goal of 60%.

Conclusion(s): At the start of this project, only 27% of infants under 1500 grams and 32 weeks gestational age were being assessed for initiation of oral feeds. There was a shift past our goal of 60% which started prior to initiation of interventions and was maintained throughout the project. We are continuing to work to see improvement in initiation of oral feedings and attainment of full oral feeds.


Key Driver Diagram


Flowchart for Infant Driven Feeding


Oral Feeding Assessment Completion P Chart


Postmenstrual Age at Full Oral Feeds X Bar S Chart

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Authors/Institutions: Christina R. Arand, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States; Richelle Reinhart, Children's National Hospital, Washington, District of Columbia, United States; Adrianna Jackson, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States; Sheri E. Ricciardi, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States; Jessica Madden, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States; Tara Glenn, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States