P2.I165: Mama's Medicine: A Quality Improvement Initiative to Increase Oropharyngeal Administration of Colostrum in Extremely Low Birth Weight Infants

Purpose/Objectives: The goal of providing colostrum as oral care to extremely low birth weight (ELBW) infants has been part of Oklahoma Children’s Hospital NICU oral care protocols for several years, although it was not explicitly stated as more beneficial than alternatives. Oropharyngeal colostrum (OPC) administration has been shown to reduce late-onset sepsis, decrease length of stay, and increase breast milk feeds at discharge. With the introduction of ELBW Nutrition Pathways in October 2022, the recommendation to provide OPC was further clarified. However, preliminary data from 9/2022-11/2022 demonstrated that 0% of ELBW infants were receiving OPC within the first 24 hours of life (HOL), and there was no change following the introduction of the nutrition pathways. We aimed to improve the percent of ELBW infants receiving colostrum within 24 HOL by 25% by 8/2023.

Design/Methods: Multi-disciplinary gap analysis revealed education, convenience, and resources as key drivers. PDSA cycle 1 included launch of NICU staff education and implementation of colostrum collection kits. Nurses were targeted in first-line education, and education was subsequently expanded to include physicians and advanced practice providers. PDSA cycle 2 included rebranding and expansion of staff education utilizing “oral immune therapy” over “colostrum for oral care” language, launch of parent education, and removal of sterile water from oral care kits. Anonymous post-education survey served as a process measure. Primary outcome measure was percentage of ELBW infants receiving OPC within 24 HOL. Data collection was expanded to include the first 4 days of life to explore additional potential barriers. Measures were evaluated via retrospective chart review. Milk administration error served as a balancing measure and remained at unit baseline.

Results: OPC administration by 4 days of life rose after protocol clarification and appeared sustained after PDSA cycle 1 but improvement was not as robust in the first 24 hours of life. Due to limited reach and effect of education, PDSA cycle 2 was initiated.
Post-surveys after education for both PDSA 1 and PDSA 2 found nearly 100% of participants were either somewhat or very comfortable explaining colostrum to families. OPC by 24 hours of life improved from 0% in 11/2022 to 60% by 8/2023. OPC by 4 days of life improved from 20% to 60% by 8/2023.

Conclusion/Discussion: In a population which already has a basic understanding of colostrum and its benefits, likely some improvement was related to awareness of a practice change rather than knowledge gaps. Although written policy creates a foundation for change, multi-disciplinary education is required for successful implementation.
Due to the similarity of OPC administration at both 24 HOL and 4 days of life, we believe efforts to improve early expression and further collaboration with those caring for postpartum mothers may be key next steps.