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Improving the Process of Enteral Nutrition Preparation With Milk Technicians

Perceptions of Cost, Time, and Quality

Brock, Whitney W. Lieutenant, Nurse Corps, United States Navy, DNP, RNC-NIC, NNP-BC; Cunningham, Craig A. Commander, Nurse Corps, United States Navy, PhD, CNOR; Brandon, Debra H. PhD, RN, CCNS, FAAN; Hoehn, Valerie BS, RD; Carter, Brigit Commander, Nurse Corps, United States Navy Reserve, PhD, CCRN

Section Editor(s): Ahern, Kathy

doi: 10.1097/ANC.0000000000000253
Professional Growth and Development

Background: Neonatal intensive care nurses have historically been responsible for preparing enteral feedings—a costly and time-consuming process that may require leaving the bedside. To address these concerns, the Milk Technician Program was implemented at a major military treatment facility. Milk technicians were specially trained and responsible for handling, storing, and preparing enteral feeds.

Purpose: To determine effectiveness of the Milk Technician Program, changes in length of time required to first attain full feeds, cost of feeding preparation, adherence to feeding preparation procedures, and nurse and milk technician role variables were evaluated.

Methods: A pre-/postdesign was used to compare length of time to full enteral feedings and cost. A plan-do-study-act design was used to evaluate protocol adherence and to identify and evaluate nurse and milk technician role variables. Data were collected via surveys, direct observations, and retrospective chart reviews to determine the overall effectiveness of this intervention.

Results: The average time for extremely and very preterm infants (<28 to 31 weeks) to first reach full feeds decreased from 32 to 19 days, t (33.1) = 2.33, P = .026, d = 0.704. Estimated feeding preparation cost savings for all infants admitted to the unit was $767 per day. Observed milk technician adherence to preparation procedures was 95.5%. Most nurses reported that the program saved time (97%) and all milk technicians reported improved job satisfaction. Nurses expressed concerns about accuracy and safety of preparation. Milk technicians reported concerns with communication, supplies, and lack of perceived support.

Implications for Practice: Milk technicians offer significant benefit to infants and nurses in the neonatal intensive care unit, including reducing time for infants to reach full feeds, saving nurses' time, and reducing costs.

Implications for Research: Further research is needed to identify ideal educational backgrounds for milk technicians and to directly measure the effect of milk technicians on hospital length of stay and infant growth parameters.

Duke University School of Nursing, Durham, North Carolina (Drs Brock, Brandon, and Carter); Department Head Nursing Research & Consultation Services, Naval Medical Center Portsmouth, Portsmouth, Virginia (Dr Cunningham); Department of Pediatrics, Duke University School of Medicine, and Duke Intensive Care Nursery, Durham, North Carolina (Dr Brandon); and Neonatal Intensive Care Unit, Naval Medical Center Portsmouth, Portsmouth, Virginia (Ms Hoehn).

Correspondence: Whitney W. Brock, NC, USN, DNP, RNC-NIC, NNP-BC, Duke University School of Nursing, Duke University Health Care System, Box 3322 DUMC, Durham, NC 27710 ( or

This work was conducted in Naval Medical Center Portsmouth, Portsmouth, Virginia.

Research data derived from an approved Duke University and Naval Medical Center, Portsmouth, Virginia, IRB protocol.

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

LT Brock, CDR Cunningham, and CDR Carter are military service members. This work was prepared as part of their official duties. Title 17 U.S.C 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.

The authors declare no conflicts of interest.

© 2016 by The National Association of Neonatal Nurses