Do You Want To Build A Milk Lab?
Building a NICU Milk/Formula Lab: Lessons Learned
The goal of this blog is to share my "hindsight" on building a NICU milk/formula lab and the key factors that contributed to its successful construction and implementation.
Throughout my career in neonatal and pediatric nursing, I've had the opportunity to transition into new clinical units. My first experience was as a charge nurse, relocating to a 45-bed NICU. This introduced me to the challenges of change management, including new clinical workflows, advanced technology, and effective transition planning.
Later, as a travel nurse, I supported nursing leadership in constructing and transitioning into two other NICUs. One aspect I hadn't encountered before was creating a centralized feeding preparation area, also known as a "milk lab" or "formula lab."
Fast forward to 2020, I was recruited as a Nurse Manager to lead the build of a new 40-bed level III NICU, which included a milk/formula lab staffed with technicians to prepare all human milk and formula products for our neonatal patients.
This was uncharted territory for me, and I had to learn quickly. As leaders, we know hindsight is 20/20. I've reflected on what worked and what didn't, and compiled a list to help future nurse leaders facing similar challenges.
Staffing: "Making the Case"
A sound staffing plan for centralized feeding preparation is essential. Consider the following:
How many FTEs? Look at your average daily census to calculate the number of feeds prepped per day.
Units Served: Review the number of units served by the prep room, as this affects labor requirements and delivery areas.
Shift Length and Hours: Decide on 8 or 12-hour shifts and the hours of operation.
Milk Runs: Determine the number of deliveries to clinical areas per day to ensure patients have unexpired feedings.
Staff Qualifications: Technicians usually have a dietetic/nutrition background. Ohio State offers an online certification course for NICU feeding technicians.
Backup Support: Registered Nurses can serve as backup support for staffing challenges.
Oversight: Depending on FTE size, the team may need a lead or manager/director. Consult with senior leadership.
Compliance and Regulatory
Donor Human Milk (DHM): Work with your quality department to meet tissue bank requirements. Document DHM receipt, lot numbers, and state upon receipt (frozen vs. thawed).
Equipment/Appliances: Ensure all equipment meets compliance with regulatory bodies (e.g., The Joint Commission, OSHA).
Bead Baths: Use waterless baths for infection control.
Commercial Dishwashers: Required wash temperature of 66°C (150°F) and rinse temperature of 82°C (180°F).
Storage: Use refrigerators and freezers with monitored temperatures. Consider a wireless continuous monitoring system like TempTrak.
A significant portion of my knowledge came from the Pediatric Nutrition Dietetic Practice Group publication, which serves as a guideline for human milk and formula storage, handling, and preparation.
In addition to this resource, you have others in your own organization. During the development of feeding workflows, engage your nutrition and nursing staff. When ensuring appropriate compliance policy and protocols, seek out the knowledge from your Quality and Regulatory leaders.
There is a steep learning curve for all stakeholders, but one thing NOT to do is “fake it to make it.” When all else fails, follow one of the most important tenets of any High Reliability Organization (HRO): Defer to Expertise.
I hope this will help all of my fellow leaders as they take on this new adventure! I can guarantee it is very rewarding and adds one more tool to your leadership toolbox.
References
Steele, C. (2018). Best Practices for Handling and Administration of Expressed Human Milk and Donor Human Milk for Hospitalized Preterm Infants. Frontiers in Nutrition, 5(76). doi: 10.3389/fnut.2018.00076
Steele, C., & Collins, E., eds. (2019). Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk & Formula in Health Care Facilities, 3rd Edition. Academy of Nutrition and Dietetics.
about the author
Dominic Petrovia, MS, RNC-NIC, is Clinical Practice and Compliance Manager at Keriton. He’s a registered nurse and has worked in health care for over 16 years.