Breast Milk Safety in the Hospital: What We Can Learn From Recent Events

When one Pennsylvania facility discovered breast milk–related errors in its neonatal intensive care unit (NICU), its outreach to the Patient Safety Authority (PSA) prompted a closer look at similar events occurring in hospitals statewide. Breast milk has been shown to be beneficial for newborns and infants,¹ including patients in the NICU,² where feeding with a mother’s own milk is associated with reduced risk of necrotizing enterocolitis,^3,4 late-onset sepsis,^3,4 and chronic lung disease.⁵ Due to these protective effects, breast milk is increasingly treated as a therapeutic product (similar to medication) that requires the same precautions afforded to any high-risk clinical intervention.^6,7

Despite its benefits, the process of collecting, labeling, storing, and administering breast milk in the NICU is complex and can be vulnerable to error.⁷ A mother’s own milk must be expressed, labeled, transported, stored, tracked for appropriate expiration dates and times, thawed, fortified, and administered, with care taken at each step. Errors such as contamination,⁸ mismatching the mother’s breast milk to the infant it is given to,^7,9 and feeding expired breast milk⁹ can occur at one or multiple points in this process and compromise patient safety.⁸ The consequences of these errors could include transmission of an infectious disease, bacterial growth, and emotional harm to the family.

A review of event reports recently submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) found breast milk errors at facilities across the state that included administration of expired breast milk, fortification errors and omissions, and breast milk that was fed to the wrong infant. Below are strategies found in the literature and/or adapted from current practice and lessons learned from PA-PSRS reports that can help mitigate the patient safety risks associated with breast milk use in the hospital.

Safety Strategies

Technology-Based Safeguards:

• Use barcode scanning^6,10–12 to match the mother’s breast milk to the correct infant^13,14 and automatically calculate fortification requirements¹³

• Ensure refrigerators/freezers used to store breast milk are equipped with alarms that will engage when an unacceptable temperature is detected⁷

Verification of Patient Identity:

Verify two patient identifiers prior to breast milk administration¹⁵

Standardized Procedures for Oversight and Storage:

• Ensure all breast milk is labeled correctly before being placed in storage⁷

• Require independent verification by two staff members¹⁴ (e.g., registered nurses, dietitians) for the placement and removal of breast milk from storage

• Ensure all movement of breast milk is documented¹⁴

Scheduled Expiration and Quality Checks:

• Remove or freeze breast milk nearing expiration date/time

• Verify storage unit cleanliness⁸

• Confirm accuracy of labeling

Discharge Reconciliation:

Establish and implement procedures for reconciling breast milk when the infant is discharged from the unit or hospital¹⁴

Putting Strategies Into Practice: One Facility’s Experience

One facility shared its experience with identifying breast milk errors and implementing mitigation strategies to strengthen its breast milk management processes. After recognizing that breast milk errors had occurred, the facility sought guidance from PSA and received resources on breast milk management and safety.^6,10–12 The facility immediately implemented many of the strategies outlined above as well as some facility-specific policies. These included designating lactation consultants as a primary contact for families requesting stored breast milk for feeding in the NICU and placing signage outside of patient rooms to indicate that stored breast milk is being used.

The facility plans to add competency evaluations and validation for all NICU staff and is exploring the integration of barcode-scanning technology into existing processes to further strengthen breast milk handling and safety practices. Routine audits of milk storage infrastructure and segregation processes will also continue to ensure patient safety and maintain the trust of patients’ families.

In the months since these mitigation strategies were implemented, the facility has reported no breast milk–related safety events. The corrective actions have strengthened breast milk management at this facility and closed the gaps highlighted by prior events. These improvements will also be enhanced with planned technology upgrades and staff competency verification.

This facility’s experience underscores how targeted interventions can improve breast milk management and reduce safety risks in the NICU. By sharing these events, lessons learned, and effective strategies, we aim to promote consistent, reliable practices across facilities and support safer care for infants and their families.

Facilities should take this opportunity to review their own breast milk handling processes and address any gaps identified. PSA resources on breast milk management and safety are available to support these efforts. These can be found on PSA’s website under Patient Safety Topics & Toolkits/Breast Milk, and we encourage Pennsylvania facilities to reach out to their patient safety advisor for guidance.

Disclosure

The authors declare that they have no relevant or material financial interests.

About the Authors

Christine E. Sanchez (chrsanchez@pa.gov) is a research scientist on the Data Science & Research team at the Patient Safety Authority. She is responsible for utilizing patient safety data, combined with relevant literature, to develop strategies aimed at improving patient safety in Pennsylvania.

Shirley Dominick (shdominick@pa.gov) is a patient safety advisor on the Outreach & Education team at the Patient Safety Authority. In this role, she guides, educates, and collaborates with healthcare facilities in Pennsylvania to reduce harm.