Task-shifting for lactation support to enhance mother's own milk use in neonatal intensive care unit: a quality improvement initiative.

Mother's own milk improves outcomes for sick and preterm neonates, yet its use in many neonatal intensive care units (NICUs) remains suboptimal. This quality improvement study aimed to increase proportionate consumption of expressed breast milk (EBM) in the NICU and exclusive (EBF) and any breastfeeding (ABF) at discharge by ≥20% above baseline within 12 weeks using sequential Plan-Do-Study-Act (PDSA) cycles and sustain gains thereafter. Root-cause analysis identified poor role clarity in lactation support. In the first implementation phase, neonates receiving <50% EBM were identified during thrice-weekly huddles, and a postgraduate resident provided individual lactation counselling. Although effective, this approach was not sustainable. In the second phase, a nursing orderly was trained as lactation support staff to deliver structured, video-assisted group counselling thrice-weekly. These processes continued through a 1-year sustenance phase. Outcomes were the proportion of EBM volume consumed relative to total milk volume in the NICU and proportions of neonates discharged on EBF and ABF. Balancing measures included feed intolerance, late-onset sepsis, and in-hospital mortality. Data were analysed using p- and u-charts. Proportionate EBM consumption increased from ∼10% to a sustained 44%-61%. EBF at discharge increased from 21%-23% to 48%-74%, and ABF from 57%-59% to 79%-97%. Staffing gaps during sustenance were addressed through administrative support and inclusion of additional nursing orderlies. All balancing measures showed declining trends. Task-shifting structured, video-assisted group lactation support to trained ancillary staff was feasible and led to sustained gains, offering a practical framework for strengthening lactation support in NICUs with limited human resources.