Breast Milk Verification

It is part of our MAR on EPIC. We scan the breast milk/ special formula (anything not ready-made bottles) bar code as we would scan a med.

Moms are given sheets of labels (name, med record number, DOB, barcode) to take home with them. We can't accept the breast milk bottles unless the mom has placed the label on each breastmilk bottle. It insures that the bottles are not mislabeled.

Special formula (formula that is fortified for extra calories) have the same breastmilk barcode labels that are placed on the bottle by our formula techs.

^We do the same - scan it into our MAK like any other medication.

Breastmilk is now treated like a med admin through EPIC. Scan the pt, scan the med (breastmilk label). Errors can still occur when proper protocol is not followed. We must always be diligent and not take short cuts!

I've always scanned milk in Epic; at one facility, milk was scanned as a PRN med, at another it scanned straight into the feeding flowsheet.

To play the devil's advocate, I worked at one facility when barcode scanning was rolled out and we ended up having a ton of milk errors in the process. It's hard to say whether we'd always had milk errors and the scanning system simply brought them to our attention or if it made the problem worse, but the error incidence significantly increased (meaning the wrong milk actually got to the baby, not that the system caught 'near misses' pre-admin). I think a lot of it has to do with workflow. It isn't sufficient to simply slap a barcode on your milk bottles; you have to think about ensuring that computers are readily available at any area where milk will be transferred to a new container (refrigerator, prep area, warmer, bedside). This brings up a bunch of issues related to resource allocation, infection control, HIPPA/label disposal.

Notably, neither facility used scannable labels on mixed, refrigerated bottles of formula, which seems ridiculous to me. One error occurred when a nurse gave a bottle without scanning it because she thought it was her baby's formula; it turned out to be a different baby's breastmilk. If breastmilk and formula are stored in the same containers, they really ought to both be scanned (or go through whatever double-check process the facility has).

My unit is starting with EPIC in January and I really hope breast milk scanning is incorporated! Right now we don't scan any milk at all, it just gets charted as the type of milk (breast, formula, donor) and then you have to have another RN verify the patient number if it's breast or donor. When moms pump they have to put one of baby's labels on the bottle, but there are no barcodes involved. Gets time consuming to have to go back and all verify each other's charting making sure that whoever you checked the label with also signs their name into the charting.

Just by talking to others, I've heard a lot of errors are made when the nurse gives the milk without scanning first. From what I hear, the scanning process can be slow and too time consuming, so when then the nurse is super busy it's just easier to skip that step. Does this seem the case? "

It isn't time consuming at all, it is just like scanning a med, you have the chart open, scan the patient label, scan the bottle/syringe with the label before you hang it.

Our flow sheet shows a red mark in one of the boxes, if it isn't there, then it wasn't scanned. We do audits on it since it is hospital policy.

Ours is within the epic system. I'm not sure if it got programmed in or if it got piggybacked on.

We recently created a new breastmilk scanning system called Keriton Kare.

We co-innovated it with Penn Medicine as the need for a new system came directly from our nurses -

1. They refused to use Epic's breastmilk scanning system since it treats breastmilk as a medication. This is fundamentally incorrect as BM should be treated as a "substance".
   
2. Epic/Cerner's system do not validate the feeds when you thaw/combine/split/discharge breastmilk
   
3. In other systems like Timeless or Safebaby - they had to constantly re-label the bottles and the worse is when they had to enter all the data upon receiving 12-15 bottles from each mom every day!
   

So we re-designed breastmilk management -

1. Instead of a single solution, we launched 2 apps - an app for the moms and an app for the nurses.
   
2. When bottles are received at the NICU, they already have the data inputted, nurses just have to scan them in *like at baggage check-in*
   
3. Robust validations at every step - thaw/combine/split/discharge
   
4. No bottle relabeling after every step - the system does smart expiration management
   
5. Integrated Donor milk management as well
   

And more, we built real-time lactation dashboards, so you can see how well your moms are pumping and proactively counsel them. We also built secured chat and photo sharing tools on the same platform.

To date, we have reduced expiration of breastmilk by 50%, helped moms achieve better pumping outcomes and made the process much safer at the NICU.

We had a simple aim - not just create the best breastmilk scanning system, but also help improve pumping outcomes for NICU moms.

PS: I was a Masters in Robotics student at UPenn when couple of nurses from Penn Medicine came to our hackathon - PennApps - to share this problem statement. I have a background in solving process orchestration problems and I could relate to this problem as my sister had a NICU baby in 2011. We won that hackathon and thus Keriton was born.