Category: Professional Posters
Purpose: Martin Luther King, Jr. Community Hospital (MLKCH), a 131-bed inner-city safety-net community hospital, cares for sixty Level One neonates monthly in its Perinatal Department. The Baby Friendly Hospital Initiative (BHFI), sponsored by WHO and UNICEF, designates hospitals as baby friendly when they have followed specific programmatic steps to support successful breastfeeding. MLKCH implemented components the BFHI in 2016 to provide nursing, parent, and medical staff education to improve couplet care. However, rates of formula usage continued to exceed organizational goals. MLKCH sought to leverage pharmacy automation and robotics in 2018 to reduce formula usage and further improve exclusive breast-feeding rates.
Methods: Prior to automation implementation, formula was stocked by materials management as a departmental supply item. As such, the product was readily available for staff provision and usage without digital controls or tracking. Upon project initiation, pharmacy acquired control of all formula distribution in the hospital and dispensed formula only from automated dispensing systems (BD Pyxis ES) in the Perinatal Department. With this additional level of control, formula required an order from the prescriber in the electronic health record (EHR) prior to dispensing from Pyxis. To avoid workflow disruptions or delays in care, MLKCH built the formula order within an electronic order set configured to auto-verify in the pharmacy’s order management system (Cerner Millennium). At the Pyxis, formula was non-overrideable with a clinical data category warning constructed to query the nurse before removal. As such, nursing staff could only obtain formula subsequent to a physician order and after answering a query/reminder to prioritize use of breast milk. Data management techniques included tracking number of prescriber orders for formula, appropriateness of use by prescriber, barcode medication administration rates, as well as automated dispensing statistics linked to the respective prescriber orders and formula dispense activity.
Results: With increased focus on systems, data, and staff accountability during this initiative, formula purchases decreased by 70% relative to annualized Materials Management purchases . Relative to pharmacy project initiation baseline, monthly formula usage decreased by 25%, and percentage of neonates requiring formula decreased by 29%. In addition to the intended product management goal, treating formula as a medication orderable also resulted in improved safety processes with bar-code administration rates for formula exceeding 95%. As the project matured, MLKCH leadership observed via frequency analysis that a subset of neonates each month received less than three bottles total over their entire stay. A second round of education and addition of automation query messaging reduced the frequency of this low-usage formula consumption by 64%. Beyond reducing formula usage and cost, this initiative improved exclusive breastfeeding rates by 20%.
Conclusion: MLKCH sought to improve the care of neonates by collaborating with the BFHI to promote breast-feeding and prioritize the use of breast milk over formula. By implementing required EHR ordering of formula by prescribers, pharmacy dispensing automation, and nursing/medical staff education, formula usage decreased and exclusive breastfeeding rates increased without adversely affecting prescriber, pharmacy, or nursing staff workflow.