Timeless Breast Milk Scanning

[SunnyRN2006]

Hi everyone,

My facility currently utilizes breast milk barcode scanning in EPIC. Once it is scanned, the breast milk verification is visible in the flowsheet under the intake/output tab. A second RN must document a verification in the flowsheet.

It seems Timeless Breast Milk Scanning will be implemented sometime toward the end of 2019. From my understanding, parents are given labels to label the milk at home, and the nurses must re-label the milk when they bring it in and scan the patient and scan it into EPIC? Then also re-label it when it is fortified? We will not have a breast milk technician. RNs prepare/fortify milk and only prepare 1 feeding at a time. We may use the leftover milk for the next feeding but are not allowed to fortify 12 hours of milk. The evidence-based rationale is that the fortified milk osmolality increases with each hour, thus increasing the risk of NEC.

For those who utilize Timeless Breastmilk Scanning,

What do you think of the system?

Do you scan from the flowsheet in EPIC or from the MAR? Or a different tab? Where is the documentation visible when scanning is complete for the breast milk intake from parents and for the administration of fortified milk?

What is the re-labeling process like? Do you feel it is adding extra work or increasing the risk of error in any way because nurses are trying to work around the process? What would make the workflow ideal at the bedside?

Does your facility utilize breast milk technicians? Is it realistic for this process to occur in a very small nutrition room that feels crowded with 2 RNs? Each RN will be fortifying milk every three hours prior to preparing the feeding syringe/bottle.

I will be on the committee for the transition to this system and your feedback will be extremely helpful in anticipating challenges and possible solutions. Thank you so much for any input!

[NICU Guy, BSN, RN]

We use EPIC, but do not use Timeless Breast Milk Scanning. Moms are given two sets of labels. The first has lines for the mom's current meds, date and time it was pumped, refrigerated time and date, frozen time and date, thawed time and date. The second set of labels are bar code labels with the baby's information on it. Breast milk is treated like a medication. The baby's wrist band bar code and the milk bar code is scanned from the MAR when we are warming the milk for the feed. If the milk is to be fortified, our formula techs print out all the orders and retrieve the milk from the fridge/freezer at around 12 noon. They deliver the fortified milk around 4 pm. The nurse signs the log to verify that the order and the label on the bottle matches ( Mother's Breast milk fortified to 24 cal. ). The fortified milk is used for 24 hours (4 pm- 4 pm). The bar code label on the fortified milk is the same label as the bar code labels that the moms put on the breast milk bottles. We do not do a second nurse verification since it is treated like a med and Epic will give a warning message if the baby's bar code and the milk bar code to not match before feed.

[Imyournursetoday]

I used Timeless at the last NICU I worked at. Initially it was tricky getting used to the flow and learning the intricacies of the program, but it worked out.

"Receiving" milk: When it came to receiving the milk, the milk had labels place by the parent. We used Timeless to create these labels by scanning baby's id tag and then printing off Timeless. So when the milk came in labeled we "received" it into Timeless. "Receiving" it meant scanning the label, each of which had it's own identifying alphanumeric id, and typing in date/time pumped. This would print out another label (which would display the expiration date/time ) we would then adhere to the bottle, and this would become the new label we would scan before feeding it to baby.

For a feeding we had to scan baby then scan milk barcode (and that had to reflect within half an hour of charted feeding time-a unit specific thing) and log it as fed, disposed, etc. The milk techs would know if we weren't scanning because the would see the milk as available when in reality it might of already been disposed of. We also had to keep track of other things like "moving" the location of the milk, for example, if in Timeless it showed as being in freezer and we moved it to a Pt room's refrigerator then we had to remember to do that within Timeless.

Imagine if it was a mom coming in after a week of not being there- that's a lot of milk to "receive," and when you are busy then it had to wait or someone could help you do it. If it came in frozen then the milk techs would want us to leave it for them to receive since they preferred to weigh it and "receive" it. I was a good thing when a mom came in with a cooler full of frozen milk; we would just make sure it had Pt labels on them and take that to the milk room. So little things like that changed the work flow and you had to make time for it sometime in the shift, but I felt it got easier over time.

The hospital implemented this system so that we could increase our safety in the administration of the right milk to the right baby, to keep from administering expired milk (exp date/time were clear and there was no confusion about this per the info on the label), and to keep better track of milk as it moved around- no more "lost" milk. I'm all for Pt safety and this system was easy to adjust to after a few weeks. We had "super users" who knew Timeless well so if we got hung up on something we always had a resource no matter the shift. Also, it helped that we had milk techs because they took on the function of all milk fortification and creating new labels in Timeless that reflected this. BTW, scanning the milk before administration showed in up EPIC (I forget what the tab was called, but it was not the MAR), but receiving and disposing and changing locations were actions performed in Timeless. Feeding a baby became a two step process as you can see -scanning for EPIC and then disposing of it in Timeless.

Hope my lengthy response answers your questions.

[vintage_RN, BSN, RN]

Our unit just started with timeless. I think it’s a big waste of my time and just more things to add to the RNs duties. Before we always had DAs who checked and made all our feeds. Now the RN has to do all this labeling and computer entry, and sometimes even make our feeds if the DAs are too busy...isn’t that what we have DAs for? Seems more things that other disciplines can now offload onto the RN.

[Keriton_Kare]

NICUs and children's hospitals have told us Timeless does require A LOT of bottle re-labeling. Also, that the recipe calculator is wonky and milk, donor milk, and formula workflows don't align.

With Keriton, you never have to re-label a bottle. We also help moms produce and bring more milk into the NICU (which you DON'T re-label upon receipt). That also means less donor milk to buy.

Here's how it works: