Improving Donor Human Milk Use Over Formula in the Well-Newborn Nursery: A Quality Improvement Work in Progress

BACKGROUND: Pasteurized donor human milk (PDHM) is recommended when maternal milk is unavailable; however, its use during birth hospitalization for term newborns is inconsistent. Understanding barriers to PDHM use is essential for improving implementation of PDHM over formula for medically indicated supplementation of breastfeeding. METHODS: = 3). Semi-structured interviews were conducted and analyzed using inductive thematic analysis with a constant comparative approach to identify key barriers to the use of PDHM over formula for supplementation. RESULTS: Three major themes emerged. First, logistical and access barriers included delays in PDHM retrieval, limited unit availability, and time-sensitive clinical scenarios, leading to preferential formula use. Second, institutional requirements for PDHM documentation and workflow are burdensome and include dual verification requirements and manual documentation that disrupted clinical workflow. Third, patient- and family-level related barriers include limited baseline knowledge about PDHM, concerns about donor safety, cultural and religious concerns about PDHM, and negative influence regarding PDHM from family members. CONCLUSIONS: Underutilization of PDHM at this hospital site during well-newborn birth hospitalization is driven by a combination of operational inefficiencies, workflow challenges, and sociocultural factors. Interventions to improve PDHM uptake should focus on streamlining access and documentation processes while enhancing early, culturally responsive parent education. Future evaluation will assess whether targeted system-level changes improve the feasibility and acceptability of PDHM use in clinical practice.