• Karen Fugate, Ivonne Hernandez, Terri Ashmeade, Branko Miladinovic, and Diane L Spatz.
• J Obstet Gynecol Neonatal Nurs. 2015 May 1; 44 (3): 426-38; quiz E14-5.

ObjectiveTo determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mother's own milk (MOM) at initiation of feedings and at hospital discharge.DesignContinuous quality improvement (QI) process.SettingUrban, 82-bed, Level-III NICU.PatientsVery- low-birth-weight (VLBW) infants weighing fewer than 1500 grams.InterventionThe Ten Step method was implemented during a 3-year period.MeasurementsProcess measurements included percentage of VLBW infants receiving MOM at initiation of feeds, number of mothers of VLBW infants with hospital-grade electric breast pump at hospital discharge, and number of mothers of VLBW infants initiating pumping within 6 hours of delivery. Outcome measurements included percentage of VLBW infants with any human milk at discharge to home and parent satisfaction with nurses' support of mother's efforts to breastfeed. Balancing measurements included percentage of VLBW infants at less than the third percentile for growth on the Fenton growth chart at discharge and receiving pasteurized donor milk (PDM).ResultsSignificant improvements were achieved in the percentages of mothers expressing their milk within 6 hours of delivery, infants receiving MOM at initiation of feeds, and mothers with a hospital-grade pump at discharge. Improvements in these processes resulted in increased parent satisfaction with nurses' support of breastfeeding and a 3.1-fold greater odds of the VLBW infant receiving MOM at discharge in 2013 compared to 2010 (odds ratio [OR]= 3.01, 95% confidence interval [CI] [1.75, 5.17], p < .001). Despite an increase in the use of MOM, there was not a significant increase in VLBW infants discharged at less than the third percentile for growth, and initiation of PDM did not negatively affect the percentage of VLBW infants with any human milk at discharge.ConclusionsImplementation of the Ten Steps method using QI methodology resulted in significantly improved rates of use of MOM at initiation of feeds and at hospital discharge.© 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

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