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Use of Healthcare Failure Mode and Effect Analysis (HFMEA) to Quantify Risks of the Human Milk Feeding Process

Zhang, Beilei (Belinda) PhD, MHA; LaFleur, Elizabeth A. BSN, RN, IBCLC, RLC; Ballweg, Diane D. MSN, RN, CCNS, RNC-NIC; Mulholland, Kristi L. BSN, RN, RNC-NIC; Wild, Jodi A. MSN, RN; Shedenhelm, Heidi J. MSN, RN, NE-BC; Stirn, Susan L. MSN, RN, NEA-BC; Gannon, Janet L. MA; Fjerstad, Kelly A. MSN/MBA, RN; Morgenthaler, Timothy I. MD

doi: 10.1097/NCQ.0b013e3182a61555

The complexity of the expressed breast milk feeding process in the neonatal intensive care unit was not fully appreciated until we used a healthcare failure mode and effect analysis. This approach identified latent risks and provided semiquantitative estimates of the effectiveness of recommendations. Findings demonstrated nursing interruptions and multitasking requirements contributed to risk, emphasizing the need for focused and isolated expressed breast milk handling to improve patient safety and outcomes.

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Division of Systems and Procedures (Dr Zhang), Department of Nursing (Mss LaFleur, Ballweg, Mulholland, Wild, Shedenhelm, Stirn, and Fjerstad), Quality Management Services (Ms Gannon), and Department of Internal Medicine (Dr Morgenthaler), Mayo Clinic, Rochester, Minnesota.

Correspondence: Timothy I. Morgenthaler, MD, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

The authors thank Dawn P. Bergen for her editorial assistance. The authors also acknowledge those working in the neonatal intensive care unit at Mayo Clinic in Rochester, Minnesota, and the Mayo Clinic Children's Center for their support of this study.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: July 20, 2013

Published ahead of print: September 18, 2013

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