Providing Unit-Wide Education: Problems and Solution

by Sue Ludwig and Kara Ann Waitzman

Feeding practices vary between NICUs and even between caregivers within the same NICU¹. We’ve long been on a journey to rectify that issue and advance oral feeding practice in the NICU.

Before 2013, we traveled to individual NICUs and taught our all-day Infant-Driven Feeding® (IDF) seminar for 1-3 days depending on staff size. Our goal at that time was to educate as many staff members as possible in the comprehensive IDF Model of Practice.

While this was reported to be a truly valuable seminar for those NICUs, we realized that this method of education was missing the mark somehow. Below are just two of the challenges NICU leaders and feeding champions taught us over time – do they sound familiar to you?

  1. Hospital Investment:

It was expensive for the hospital to invest in this method of education due to:

  • Paying staff to work in the unit over the duration of the seminar – sometimes overtime to cover all the shifts while everyone else was in the course
  • Also paying staff to attend the course itself
  • Speaker honorariums
  • Speaker travel and lodging
  • Staff time to establish, organize, and then manage the event
  • Ongoing staff time to educate new hires
  1. Consistency and Scalability:

After the live seminar, there was no way to effectively transfer 6+ hours of knowledge (taught by the creators of the Model) to new hires. That lack of continuity can negatively affect even the most rooted of practices imperceptibly over time.

In the original teaching model, the hospital also assumed that one of the feeding champions would be able to distill this in-depth and complex content into a 1-hour in-service provided to all new staff. Over time, we noted that this was not efficient or sustainable. It might work for a year or so, while 90% of the caregivers were among those originally and fully educated, but eventually, it was prone to erosion.

The new hires grasped the WHAT of the IDF Model but rarely the WHY and the HOW. Or they believed that using our tool, the Infant-Driven Feeding Scales©, was synonymous with practicing the Infant-Driven Feeding® Model of Practice, which is not so.

To be clear – this is not the fault of the feeding champions. As the Co-Founders of IDF, we could not effectively teach this model in one hour either. The successful transition to oral feeding in this fragile and often medically complex population is not that simple. We need only to refer to long term pediatric feeding outcomes and well-documented parental feedback to verify that. Babies and families suffer when our practices are scattered

The Solution

We were determined to better serve our colleagues and to ensure that babies and families benefitted from a consistent, valid, comprehensive, family-centered, and Infant-Driven Feeding® practice.

The solution: transfer the all-day live seminar content to an Online IDF Course that hospitals could purchase and assign to all NICU staff via their learning management system where staff education already lives.

Therefore, since 2014, the only approved way to confirm your NICU is adequately educated in the entire Infant-Driven Feeding® Model of Practice is to ensure every bedside caregiver (nurses, neonatal therapists, lactation consultants) has taken the comprehensive Online IDF Course and that new hires receive the same educational experience. For the reasons stated above and more, this is the most cost effective, valuable, scalable, and successful way to get your entire NICU on the same page- finally- about oral feeding.

We can’t wait to help you along the way.

¹ McGrath JM, Medoff-Cooper B, Hardy W, and Darcy AM. Oral feeding and the high-risk infant. In: Kenner C, McGrath JM, eds. Developmental Care of Newborns and Infants: A Guide for Health Professionals. Glenview, IL: National Association of Neonatal Nurses; 2010;313-348.