Impact of a VLBW feeding guideline on central line usage and enteral feeding practices: A quality improvement project

BACKGROUND: Feeding guidelines (FGs) reduce the incidence of necrotizing enterocolitis (NEC) and improve growth and enteral nutrition (EN) practices in very low birth weight (VLBW) infants. Our unit's baseline data revealed delayed initiation of EN, prolonged time to full EN, prolonged days on parenteral nutrition (PN), and frequent use of peripherally inserted central catheters (PICC). After introduction of this FG, our specific, measurable, attainable, realistic, and time-bound (SMART) aims were to reduce PICC placements in infants 1000-1500 g by 30% and to reduce the time to achieve full EN in VLBW infants by 20% without adversely impacting NEC rate, growth, and mom's own milk (MOM) provision. METHODS: We conducted a time-series quality improvement initiative over 48 months. Outcome and process measures included the percentage of PICC placements, nutrition-related central line days, day of life (DOL) EN initiated, and DOL on full EN. Balancing measures included NEC, growth, and MOM provision. Two-tailed t-tests, Mann-Whitney U tests, and chi-square tests were used to analyze demographic data, numerical variables, and categorical variables, respectively. Statistical process control charts and established rules for special cause variation were applied. RESULTS: Our results demonstrate a 54% reduction in PICC placements and a 38% reduction in time to achieving full EN. We saw no increase in NEC rate but observed a decrease in growth and MOM provision. CONCLUSION: The use of a standardized FG resulted in fewer PICC placements and decreased time to full EN without increasing the NEC rate. Future initiatives will focus on improving growth and MOM provision in VLBW infants.