Abstract
Purpose: The purpose of this quality improvement project was to implement an infant-driven feeding tool in an effort to transition to a uniform infant-driven feeding culture in the Neonatal Intensive Care Unit (NICU).|Background: Oral feeding is a complex, multifaceted endeavor for preterm infants. Initiating and mastering oral feedings in the preterm infant is one of the steps to assure appropriate growth and determine an infant’s readiness for discharge from a NICU. The use of an infant-driven feeding tool assists parents & caregivers to identify cues and stressors in the infant prior to, during, and after feedings, which can decrease the length of stay and support a positive feeding outcome in the infant.|Sample/Setting: The setting was a Midwestern, Level II-III NICU.|Methods: Education was provided to nursing staff on The SOFFI Method of feeding premature infants with documentation on the Early Feeding Skills checklist within the infant’s electronic medical record. Following implementation, a quality improvement process examination (audit) was performed by reviewing charts on infants currently in the NICU (n=29). A follow-up survey regarding NICU nurse perception of feeding practices took place following implementation of the new infant-driven feeding tool.|Results: Chart audits revealed a compliance rate ranging from 16-27%. Forty-three percent (43%) of respondents on the survey had more than seven years of experience as a NICU RN, and 73% percent of respondents had been working in the same NICU during that time. Ninety-three percent (93%) of the nurses stated that the unit uses a feeding readiness tool. The majority (67%) believed all members of the interdisciplinary team decided when the infant was ready to participate in oral feedings. The criteria used to initiate oral feedings in the NICU included: gestational age (85%), respiratory status (92%), infant displaying cues (100%), and infant successfully sucking on pacifier (85%). Factors that delayed or altered oral feedings included: gastric residuals (100%); abdominal distention (100%); respiratory status (100%); gestational age under 34 weeks (92%); respiratory rate above 60 breaths per minute (77%); other conditions (cleft palate/inotropes/unstable status) (77%); weight under 1500 grams (46%); provider resistance to advancing feedings (15%); and nursing resistance to advancing feedings (23%). Forty-six percent (46%) stated an infant’s feeding is successful when the infant consumes the entire volume of feeding. Factors that stop oral feeding: infant appears disinterested (100%); infant choking (92%); apnea/bradycardia during feeding (92%); infant desaturates (92%); infant appears sleepy (92%). Oral feeding success was measured by: infant nipples with a strong, coordinated suck (100%); does not experience desaturation during feeding (92%); does not experience apnea/bradycardia during feeding (92%); consumes entire volume of feeding (46%).|Conclusions: The majority of NICU nurses did not comply with this practice change. Despite education on the SOFFI Method, a few respondents were still unaware that their unit used an infant-driven feeding tool. A turnover in management occurred during the implementation process; therefore, the success of the implementation strategy was limited.