A Quality Improvement Project to Increase Breastfeeding Rates in the NICU.

The Baby-Friendly Hospital Initiative strives to increase exclusive breastfeeding rates. Research findings suggest that NICU nurses' actions and support may be a key factor in increasing breastfeeding rates. Our needs and feasibility assessment identified a NICU lacking a NICU-specific breastfeeding policy, and a review of the electronic health record (EHR) showed nurses did not assist patients with breastfeeding. We conducted a quality improvement project that included the creation of a NICU-specific breastfeeding policy, educational inservices, and real-time coaching for nurses. Additionally, pre--post questionnaires were administered to the nurses, and a review of the EHR was performed to assess nurse-assisted breastfeeding attempts pre and post project implementation. Thirtysix (80%) nurses attended the inservice. Almost two thirds of nurses (63%) had adequate breastfeeding knowledge prior to the inservice. Nurses' knowledge gained from the inservice was not statistically significant from pre/post implementation of the project (t = 0.48, p = 0.32). We identified 11 nurse-assisted breastfeeding attempts in our 10-day review of the NICU EHR after project implementation. This result was compared with zero nurse-assisted attempts in our EHR review prior to this project. We conclude that a multimodal approach to support breastfeeding in the NICU may be beneficial to increase breastfeeding rates by ensuring nurses have the knowledge and skills to promote breastfeeding.