Welcome to the heart of our collaborative spirit. At CPQCC, we know that the most powerful improvements often come from the practical, on-the-ground solutions developed by NICU teams like yours. This Resource Hub is a dedicated space for sharing the innovative tools, protocols, and educational materials that are making a real difference in neonatal care. 

Explore a living library of peer-vetted tools developed and implemented by your CPQCC peers. 

By sharing what works, we can collectively accelerate quality improvement, standardize potentially better practices, and improve outcomes for our most vulnerable infants and their families. 

Browse the resource library by clinical topic. We encourage you to utilize the tools as a starting point/template and adapt them to meet the unique context of your NICU.

Nutrition

Our inaugural collection features tools from the Grow, Babies, Grow! (GBG) collaborative, focusing on high-impact nutrition practices for Very Low Birth Weight (VLBW) infants. This curated set includes checklists, protocols, and educational resources that directly correspond to the GBG Top Ten recommendations—developed from the collective wisdom and experience of participating GBG NICU teams. Explore these tools to see shared innovation in action.

Top 10 GBG Lessons Learned

  1. Hold Weekly Multidisciplinary Nutrition Rounds
    Multidisciplinary “Nutrition Time Outs” may help improve growth outcomes by aligning the team and family around real time data and opportunities for improvements.
    1. This process changes the NICU culture by supporting the team’s shared
      mental model of the importance of growth and nutrition
      1. Review infant growth and adjust nutrition plan as needed
      2. Review milk supply and possible needs for support; evaluate percentage of mother’s milk compared to donor milk
    2. Designate a role (dietitian, charge nurse, etc.) to lead Nutrition Rounds
    3. Following a script or checklist may facilitate Nutrition Rounds (Examples from Sutter Medical Center, Sacramento, and UCSF Benioff Children's Hospital)
    4. Provides an opportunity to hear from all team members and the family
    5. Nutrition Round frequency should be at least weekly, however depending on unit context may occur biweekly or as a discussion point in daily rounds
  2. Utilize Z-Scores for Growth Assessments
    Z-scores track malnutrition risk and can be integrated into the EHR for easy access and real-time review.
    1. z-score is a sensitive growth and malnutrition measure that assess growth along a continuum
    2. z-scores can be incorporated into the EHR facilitating immediate review during Nutrition Rounds (Example from Cedars-Sinai Guerin Children’s)
  3. Standardize Parenteral Nutrition Guidelines/Protocols
    1. Initiation of parenteral nutrition included in the NICU Admission Order Set and started within hours of birth
  4. Standardize Enteral Nutrition Guidelines/Protocols (Examples from Miller Children’s & Women’s Hospital, Long Beach, and CHOC Children’s at Mission Hospital)
    1. Initiation of enteral feeds included in the NICU Admission Order Set and begin < 24 hours of age with mother’s milk or donor human milk (DHM)
    2. Advance feedings per evidence-based recommendations
    3. Add human milk fortifier before 90ml/kg/day
    4. Continue to advance feeds consistently to goal daily volume after feeding protocol completion
  5. Automate Nutrition Practices in the EHR
    Design EHR-based order sets and protocols/guidelines to promote consistent practice and team alignment with nutrition processes.
    1. Streamlines order processing and improves guideline compliance
    2. Once feeding protocols have reached completion, continue to promote growth by nurse-driven volume advancement to meet the daily volume goal
    3. Hard-wires the importance of nutrition in the multidisciplinary team shared mental model
    4. Maximize use of the EHR and order sets
      1. Integrate assent/consent for Donor Breast Milk (DBM) into the prenatal consult (Example from Miller Children’s & Women’s Hospital, Long Beach)
      2. Include initiation of initial parenteral nutrition and enteral feeding protocols in NICU Admission Order Sets
      3. Automate feeding advancement via protocol via EHR
      4. If an order is required for a lactation consult, include in NICU Admission Order Set
  6. Stop Checking Routine Gastric Residuals
    Avoid using routine gastric residual checks as a default measure of feeding intolerance as this practice is not evidence-based and may slow time to full feeds without benefit. (Examples from CHOC Children’s at Mission and John Muir)
  7. Improve Nutrition Documentation
    1. Develop EHR dot phrases to improve documentation
    2. Weekly tracking of growth chart percentile and z-score with daily display and inclusion in progress notes (Example from Cedars-Sinai Guerin Children's)
  8. Track and Share Data Consistently
    Use dashboards and regularly schedule feedback loops to drive improvement. Include outcome and process metrics.
    1. Continue to track data and outcomes, sharing the results with the team
      1. Data is a primary driver of change
        1. Consider nutrition dashboard (Example from Cedars-Sinai Guerin Children's)
      2. Simplify data by enhancing EHR tracking capabilities
      3. Scheduled cadence of data collection and spot audits to ensure processes are working correctly have benefit
    2. Z-score and growth chart data as well as process data such as:
      1. TPN initiation hours since birth, TPN macronutrients, fat initiation hours since admission
      2. Time to first enteral nutrition, first colostrum administration, days to reach full enteral volume, day of first feeding fortification, day of first breast feed
      3. Compliance to Parenteral Nutrition and Feeding Protocols
  9. Formalize a Multidisciplinary NICU “Nutrition Committee”
    1. Review NICU data and processes
    2. Review new/updated evidence
    3. Plan the next PDSA cycles of change
    4. Share information, plans with entire NICU team
    5. Consider monthly feedback to the entire NICU team; Quarterly feedback to NICU senior leadership; Annual report to Organizational committees/leadership
      1. Consider a deeper understanding of each infant who did not meet growth goals – “mini” M & M or root cause analysis
  10. Spread What Works
    Share successful practice change, processes, and tools with affiliated NICUs and other CPQCC centers to accelerate learning.
Resource Category: 
Tools
Date: 
July 2026