Implementing an Oral-immune Therapy (OIT) Guideline in the Newborn ICU: An Evidence-Based Quality Improvement Project

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Implementing an Oral-immune Therapy (OIT) Guideline in the Newborn ICU: An Evidence-Based Quality Improvement Project Sandra Guillen, BSN, RN; Jessica Davidson, MD; Jenny Hearne, DNP, APRN, NNP-BC, C-NNIC Key Take Away: OIT is a safe, cost-effective, minimally invasive, and evidence-based intervention with . demonstrated benefits for premature infants and addressing barriers improves its delivery. Background • OIT involves applying breast milk to an infant's oral mucosa to stimulate oropharyngeal lymphoid tissue and aid absorption of biofactors1 • Oral drops of human milk enhance IgA and lactoferrin absorption – higher urinary levels than with milk-dipped swabs2 • Potential Benefits: prolonged beneficial bacteria colonization, reduced pro-inflammatory cytokines, lower feeding intolerance, fewer feeding discontinuations, shorter hospital stays, improved growth metrics, higher breastfeeding rates at discharge, and, in some small studies, decreased incidence of late-onset sepsis3,4,5,6,7,8 Purpose 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Implement an OIT guideline for infants born under 32 weeks gestation and not feeding by mouth admitted to the NICU Methods Results Impact of Guideline Implementation Baseline W1 Plain MM at Bedside W2 OIT W3 W4 Scanned MM for OIT Barriers Identified by RNs • Assessed current process of oral provision of mother’s milk through a RN Other survey, chart reviews, and bedside audits Parents Refuse • Developed an evidence based OIT guideline and workflow – addressed Barriers to Scanning barriers identified by RNs • Implemented OIT guideline and workflow Barriers to Preparing • Evaluated the implementation process using: Time Constraints • 1. PDSA cycles (3): Unstable Infant • Staff and parent education to boost early colostrum provision • Modified guideline to maximize eligible infants receiving OIT Staff Forget • 2. Post-survey and chart/bedside audits to analyze: Unavailability of Plain MM • OIT administration and milk scanning consistency changes 0% 20% 40% • Changes in bedside availability of plain mother’s milk • Feasibility, usability, and satisfaction with guideline and workflow Pre Post Pre 29% (n=39) and Post 21% (n=21) response rate of RN surveys sent = 134. Comparison of pre-post survey answers below. • Administration of plain mother’s milk: • Responses of always and most of the time improved from 59% to 90% after education and OIT guideline implementation • Knowledge of OIT: • Self-perceived knowledge of OIT’s benefits increased from 72% to 100% • Participant’s self-perceived knowledge of differences between OIT and oral-care increased from 49% to 95% Post-implementation survey only • Feasibility: 95% of RNs found the guideline and instructions easy to follow • Useability: 95% RNs felt guideline was easy or very easy to integrate into their current practice • Satisfaction: 90% of RNs plan to continue using the guideline to provide OIT to eligible infants Conclusions 60% 80% 100% • Infants received safer, more consistent oral exposure to mother’s milk and availability of plain mother’s milk at the bedside was significantly improved after guideline implementation and changes in workflow. • Supporting the integration of OIT into caregiver routines through continuous education will support its long-term sustainability as new staff are hired and trained • Long-term use and adherence to the guideline will optimize eligible infants’ oral exposure to mother’s milk References available upon request @uofunursing @utnurseresearch