RT Journal Article SR Electronic T1 Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue JF BMJ Open Quality JO BMJ Open Qual FD British Medical Journal Publishing Group SP e001439 DO 10.1136/bmjoq-2021-001439 VO 10 IS Suppl 1 A1 Abhishek S Aradhya A1 Inderjot Kaur A1 Rima Gupta A1 Sonaljot Kaur A1 Yamasandi Siddegowda Shrimanth A1 Parveen Darshan Masih A1 Praveen Kumar YR 2021 UL http://bmjopenquality.bmj.com/content/10/Suppl_1/e001439.abstract AB Background A three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles.Methods All preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle.Results In the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule.Conclusions It was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.All data relevant to the study are included in the article.