This document outlines the procedure for providing donor breast milk to babies in the NICU. It involves 3 main steps: 1) obtaining an order from the pediatrician, 2) preparing the milk according to labeling and safety guidelines, and 3) documenting the feeding and any remaining milk. The RN is to label the milk bottle with identifying information, log the details, warm it carefully, and ensure a double check is done if the RN will administer it.

1. Donor Breast Milk
Procedure: Check List

2. 1st: Getting the Provider Order
 Baby must meet criteria
 Inform parents, provide education
 If parents interested, page the baby’s Pediatrician
 When ped calls back, update them and obtain order for banked milk
 Stay on phone and go into patient room
 Pediatrician answers and parental questions and gains verbal consent
 Complete the template note (dot phrase) .donor breast milk

3. 2nd: Prepare the Donor Milk
 Get milk from nursery freezer on second floor
 Label the milk with the following information:
 Baby label
 Add expiration date and time on bottle (48 hours from thawed
time)
 RN initials who thawed the milk
 Complete the donor milk log sheet with the following information:
 Baby label
 Donor milk batch number
 Expiration date
 RN initials
 Indication for the use of donor milk

4.  Label a Medela liner with baby label
 Place donor milk inside the single patient use Medela liner
 Turn warmer on an run through 2 warming cycles
 Fully thawed milk should have no ice crystals present
 If the RN is going to be giving the donor milk a double check between
2 RNs or 1 RN and 1 Parent is needed and must be documented on the
doc flow sheet

5. 3rd: Final Steps
 Place a lactation consult with situation
 Initiate pumping
 Document feedings with the donor milk
 Newborn doc flow sheet
 Donor milk
 Enter lot number and amount
 Refrigerate and unused portion in the mother’s refrigerator for up to
48 hours from the thawed time