<p> The American Academy of Pediatrics (2012); the American College of Obstetricians and Gynecologists (2016); and the Association of Women&rsquo;s Health, Obstetric, and Neonatal Nurses (2015) endorses breastfeeding exclusively for six months, followed by continuation with complementary foods through age one year to achieve the most personal and public health benefits. However, while most mothers initiate breastfeeding, the majority do not meet their goals due to lack of support (CDC, 2016). </p><p> The Affordable Care Act mandates coverage for breastfeeding support, but federal, state, and insurance policies are not conducive to making such benefits accessible. </p><p> Electronic registration and medical record documentation allow for improved tracking and decreased risk to the facility. </p><p> This paper outlines the development and implementation of administrative practices in an existing Registered Nurse/Internationally Board-Certified Lactation Consultant (RN-IBCLC) led outpatient lactation clinic at a Baby Friendly (2012) designated facility with goals of increasing access to lactation support postpartum, improving patient outcomes, and realization of financial viability. Expected outcomes included identification of best practices and implementation strategies for the following: a. provider collaboration including outreach efforts to trigger referrals. b. number of dedicated hours per week to offer services. c. cost/benefit analysis. d. registration and documentation process. e. model of care. f. funding source. </p><p> Tests of change through plan-do-study-act (PDSA) cycles were based on the outcome of a gap analysis. Modifications to implementation were made dependent on PDSA cycle findings until optimized RN-IBCLC-led outpatient lactation clinic administrative practices for the facility and processes became streamlined. </p><p> Despite limited literature to guide administrative practices, the project met the aims of patient registration and electronic health record (EHR) documentation. However, extensive policy and systems barriers existed that prevented success in identifying a workable revenue stream despite the efforts of this investigator in collaboration with parent system-level managed care, finance, and compliance departments. </p><p> The solution agreed upon to provide sustainability to the program was to utilize outpatient lactation visits as a community benefit to quantify lost revenue of services provided and aid the hospital. Even though the lack of revenue equaled lack of department growth, the community benefit option added a layer of stability to the program as it stands. </p><p> This project provides a model for other organizations examining best practices in administrative and funding options for IBCLC-led outpatient lactation clinics. Thereby; creating sustainable breastfeeding support leading to improved health of mothers, babies, and the community.</p><p>

<p> A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating evidence as well as the process used in forming the practice guideline. The primary methods employed were a team approach that included a Neonatal Intensive Care Unit (NICU) Project Team and NICU expert opinion along with a literature review conducted by the doctor of nursing practice student. The NICU Project Team collected the NICU experts&rsquo; input via surveys they developed and distributed as well as e-mails to authors identified from the literature review. The surveys yielded a 76% response rate from the registered nurses and a 59% response rate from the medical providers. All data collected were shared and descriptive statistics were used to evaluate the data. One of the central research findings was that gastric aspirates should no longer be routinely obtained on stable infants and, if used in evaluating feeding intolerance, they must be used in combination with other indicators. An enteral feeding guideline was developed to reflect this finding that can be shared with other NICUs and nurseries in the United States and globally to decrease the morbidity and mortality of neonates.</p><p>