Nursing Productivity And Efficiency In Milk Management

Keriton Improves Nursing Productivity

Keeping it real

When it comes to barcoding, it may seem logical to treat breast milk like blood or medication. But the logic quickly fails. How often is blood combined with other bags of blood, then aliquoted specifically per patient before administration? How regularly is a medication frozen, thawed, and dosed out per patient administration? It turns out, human milk management is far more complex, labor intensive and time consuming by nature.

Each bottle of breast milk requires 16-20 mental validations – verifying the baby’s and mother’s identification, updating expiration dates, inventory, etc. If a nurse is manually logging five, ten or 15+ breast milk bottles at a time, then we’re talking about 80, 160 or 240 mental validations, respectively.In healthcare as in life, distraction is the enemy of productivity. Nurses, pharmacists and technicians are distracted and interrupted as often as once every two-minutes. From the onset, breast milk management is rife with opportunities for distraction (and errors).

Assuming a milk tech or RN completes 12 hour batch prep, here’s a conservative projection of how many mental validations take place per month and based on unit size. Please note these numbers increase as prep frequency increase.

NICU nurses generally have 2-4 infants in their care, eating 3-4 times in a 12 hour shift. A nurse or tech could realistically prepare 12 feeds in one day per baby. Without an assistive system, these preparations require numerous mental validations on the part of the individual.

What kinds of validations? We are talking about recipe creations, expiration updates with many rules associated, patient identifiers, multiples, volume and parsing out feeds, planning for real time and future feed times, verification of orders, changing feed orders, routes of feeding, thawing milk, freezing milk, and the list goes on.

Every validation point is a point of potential error. And if you have staff preparing feeds at the point of care, you can go ahead and triple or quadruple these numbers. For example:

while prepping feed...

1. Ok yup this is twin B. Both bottles are from twin B… ok good.
2. I have thawed milk and I just fortified it… what is the new expiration now?

Hey we are starting rounds, can you join us?

3. How do I make 26 Kcal again?
4. How many mLs is she getting again?

ALARM… ok that one is false… things are fine, mom. I will be right there.

6. Ok so I have one syringe already, but I need to make a few more and I think the order is going to change after rounds so
7. I am just going to make two.

Phone call: Mom Smith on line 4.

Streamlining the process

If a process happens tens or hundreds of thousands of times a month, doesn’t it make clinical and financial sense to streamline it? Yes! Let’s cut out the unproductive steps and minimize the amount of time spent going through the process, all without compromising safety.

Keriton is an investment in process that is a force-factor – to eliminate the bottleneck of 2-person checks, to prevent errors due to distraction or cognitive/decision fatigue, and to ensure each nurse makes the same 26 Kcal feed the first time and the 24,000th time each month.

The misappropriation of breast milk is considered a sentinel event by the Joint Commission. Best practices, policies, procedures, and ultimately the process itself is scrutinized when there is a misappropriation. In many cases, a health system had a detailed process in place but it was a “workaround” which cause the misappropriation. Workarounds are created when staff routinely deal with unproductive steps in a process.

In terms of safety, Keriton protects against two categories of errors. First, Keriton streamlines the process to prevent errors born from a mountain of mental validations. And in a second case, Keriton prevents individuals from creating ad hoc workarounds which often lead to major errors.

Keriton Improves Nursing Efficiency

In NICUs and at children’s hospitals where the stakes are high, it’s crucial that clinicians work to the top of their license. Health systems leverage Keriton to make feeding management more efficient so that nurses can do things that bring more value, i.e. patient- and family-facing care. What can your NICU nurses do with 93.7 hours more each week?

For a health system with a 25-bed average daily census, we collected time trial data pre-Keriton go live and again at five-weeks post-Keriton go live. The table below calculates the increased efficiency (labor savings) for NICU bedside nurses. Based on these results, Keriton saved $22,967 in nursing hours in five-weeks for this hospital.

Take a moment to consider this time trial data is from four of the critical steps in breast milk prep. These would be the same steps if it were donor milk too. Many health systems invest tens or hundreds of thousands of dollars each year to purchase donor milk.

Keriton drives efficiency into the prep of all human milk, which impacts the bottom line: the Capital costs of buying and shipping donor milk, as well as maintaining refrigerators and freezers to hold it. In a future post, we will delve into Keriton’s real-time utilization analytics that track the efficiency of how donor milk is being used (e.g. bottles of fed vs expired).

In the table above, also consider the 12 minutes spent before Keriton versus the 3.5 minutes after Keriton implementation. That’s an incredible amount of time saved from four critical steps that are repeated, literally, tens of thousands of times per month. Keriton simply streamlined this NICU’s process -- eliminating 2-RN checks and guiding nurses through successive steps in their workflow which helps them proceed faster, all without compromising safety.

These types of improvements to nursing efficiency translate to better employee engagement and higher rates of job satisfaction too. Given the national nursing shortage, keeping staff happier and reducing burnout also reduces turnover. That adds an economy of scale to the need for efficient, assistive technologies like Keriton for NICU nursing teams.

If safety is the first priority, the responsibility of safety does not sit exclusively on nursing teams.

In addition to the high psychological stress families experience, nurses involved in breast milk errors experience a range of emotions including horror, shame, guilt, sadness, devastation and shock. Health systems leaders have to set their nursing teams up for success by giving them technologies and processes that make the safer route the easier and more efficient route.

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