Staying LEAN in Human Milk Warming

Meredyth Thompson, BSN, RN / September 2016


Have you ever counted the number of steps you take in one shift? Have you ever considered how much waste (not trash waste, but process waste) there was in average day of a NICU RN? Have you ever thought, “There has to be a better way?”

I know I have certainly considered that question. In fact, I remember one shift in particular. I had walked almost three miles while taking care of feeder growers, all because of the inefficiency in my workplace. Don’t worry, I won’t tell you which of the several hospitals I’ve worked at that was responsible for inefficiencies on that hectic day! However, I will tell you that this happens more often than we think.

In the last several years, The National Database of Nursing Quality Indicators (NDNQI) has studied this phenomenon. Because of their findings, they launched a campaign (along with the ANA) to keep nurses at the bedside in order to reduce the multitasking that occurs each shift, and keep our focus on our patients and their families.

In addition, if you look beyond nursing to other industries, such as manufacturing, you see companies like Toyota making similar overhauls using the LEAN Management approach to decreasing waste in the workplace. In fact, as one researches this particular topic, it becomes clear that this is an issue that must be discussed and assessed in order to streamline our workplace.

So let’s explore this inefficiency concept when it comes to warming human milk. For years we have warmed milk using cup and water. We never thought there was anything wrong with it, until a better way was introduced. What we now understand is that there are several issues with this method of warming, including variable milk temperatures (too hot and too cold), a potential to alter the properties of breast milk due to high heat exposure, and let’s not forget, there is an opportunity to introduce waterborne bacteria to the feeding, regardless of using a glove to protect the bottle or syringe.

Given that last point, there is something to consider, as we know there is a lot of evidence that shows that hospital water is a potential source for nosocomial infections.1-3  The CDC has given strong recommendations to remove water from the hospital environment whenever possible as well. So, among the inefficiencies of this process, we can already list the following: the use of hospital supplies (styrofoam cup, graduated cylinder), time to heat water, time for the milk to warm, opportunity for bacterial introduction, and the degrading of the human milk properties.

So, what if there was a better way? We know today, there is a better way.  We can remove water from our warming process quite effectively given today’s innovations. We have to consider what the best way is to remove this inefficiency from our workflow.

I was recently observing the feeding process, as described above, in a NICU.  As we watched this process, we found it took the nurse 18 minutes to complete this process for one patient, for one feeding!  I was shocked.  Multiply those 18 minutes by how many feedings you complete in one shift!

How much time are we consuming to complete this lengthy task when we could do it in a fraction of the time?

What if we could reduce the warming process of a syringe feeding to just a few minutes? We could reduce our steps, our preparation time, and our care times. Imagine, as a bedside nurse, if you could go to the fridge, draw up your milk, prime the line, and start your feeding immediately, all because warming is occurring during a feed without further effort from the nurse. It’s revolutionary to consider. And it’s all possible with an in-line warmer such as the Guardian Warmer, which does not require water or pre-warming steps.

Oh, and let’s not forget to mention how decreasing these inefficiencies affects our babies. Is it possible that they would tolerate their feeding better, have less residuals, less abdominal distention, burn less calories, and grow better?  I believe they would benefit greatly from new innovations and by having more relaxed, less distracted nurses at the bedside. In closing, I ask you to consider these inefficiencies.  Consider the inefficiencies in your own facility and how you can help to reduce process waste in your hospital.


1. Anaissie Ej, Penzak SR and Dignani MC (2002). The Hospital water supply as a source of nosocomial infections: a plea for action. Archives of Internal Medicine, 162 (13):1483-92.

2. Buyukyavuz Bl, et al. (2006) Finding the sources of septicemia at a neonatal intensive care unit: Newborn infants can be contaminated while being fed. Japanese Journal of Infectious Diseases,59(4):213-215.

3. Rutala W and Weber D(1997) Water as a reservoir of nosocomial pathogens. Infection Control  & Hospital Epidemiology. 18(9):609-16.


About the Author

Meredyth Thompson, BSN, RN, is a Clinical NICU Specialist with Medela.  She has 13 years of NICU experience where she was a staff nurse, travel nurse, and nurse manager.  She has experience working in a variety of NICU’s across the nation including large children’s hospitals and small and large delivery centers.  She has a passion for developmental care, human milk, nurse mentorship, nurse manager coaching, and is a powerful change agent.  Meredyth has been trained in Lean Management Systems and has thorough experience in NICU design and expansion project management.