| Description |
Background: Prematurity in the U.S. affects approximately 10.4% of live births (CDC, 2024). Preterm infants under 32 weeks constitute about 1.6% of U.S. live births but disproportionately account for 52% of infant deaths and significant morbidity (Barfield, 2018). Literature suggests that oral-immune therapy (OIT) through oropharyngeal administration of mother's milk can stimulate the immune system by activating oropharyngeal-associated lymphoid tissue (OFALT) and may provide immuno-protective benefits for premature infants (Fu et al., 2023). Local Problem: A Level III suburban NICU lacked a standardized process for providing OIT to infants born under 32 weeks' gestation. Standard practice was oral care with a swab dipped in mother's milk or, most frequently, sterile water. Mother's milk for oral care was infrequently scanned in the system, bypassing a safety check. Methods: Surveys were used to assess staff's knowledge, current practice of providing OIT, and barriers to OIT. A literature review was conducted to identify best practices for providing OIT to premature infants. Guideline was developed by conducting an extensive literature review of quality evidence and consulting with a content expert. Staff were educated on both OIT and the guideline. The guideline was implemented, and adherence to the guideline was measured through chart reviews of OIT administration; workflow improvement was assessed through bedside refrigerator audits measuring the availability of plain mother's milk. Intervention: Pre- and post-implementation surveys assessed self-perceived knowledge and benefits of OIT, administration trends, and barriers. Baseline trends on oropharyngeal administration of mother's milk and milk scanning were established through chart reviews and audited periodically after guideline implementation. Random audits monitored the availability of plain mother's milk at the bedside. PDSA cycles were completed after guideline implementation for rapid cycle changes over a four-week period - mainly targeting education reinforcement. Staff's perceptions of feasibility, usability, and satisfaction with the guideline were appraised. Results: Pre- and post-implementation surveys were sent to 134 registered nurses; response rate was 29% (n=39) and 22% (n=21) in the pre- and post-implementation surveys respectively. Results showed significant improvements in staff's understanding of the benefits of OIT (Zscore: -2.49, p=0.01278) and knowledge of differences between oral care and OIT (Z-score: -3.73, p=0.0002); no significant change in perception of OIT being beneficial for infants born under 32 weeks' (Z-score: 1.89, p=0.05876). OIT administration frequency increased from 0 to an overall average of 4.21 times per 24 hours (Z-score: -3.71, p=0.0002). Bedside availability of plain mother's milk increased from 18.6% at baseline to an overall average of 76%. Compliance with scanning milk for OIT rose from 0% to an overall average of 90%. Post-survey responses from nurses suggested high feasibility (95%), usability (95%), and satisfaction (90%) with the guideline. Conclusion: Implementing the OIT guideline enhanced staff knowledge and understanding, increased availability of plain mother's milk at the bedside, improved oropharyngeal exposure to mother's milk, and improved compliance with milk scanning. These results suggest that adopting an OIT guideline can significantly improve clinical practices related to OIT in the NICU. |
