Publication date: 24/08/2023

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Summary: Introduction: The establishment and maintenance of breastfeeding in premature and low birth weight newborns are complex, presenting greater challenges than in full-term and healthy newborns, as the breastfeeding process can be interrupted indefinitely. This project aims to address an institutional demand for improvements in breastfeeding assistance for premature infants and is aligned with the research line of organization and evaluation of healthcare systems. Overall Objective: To contribute to the improvement of the quality of breastfeeding management in premature and low birth weight newborns. Specific Objectives: Determine the current compliance with best practice recommendations; Identify barriers and facilitators to improve compliance with best practice recommendations; Implement strategies to address areas of non-compliance; Evaluate changes in compliance with evidence-based practice recommendations after the implementation of strategies. Methodology: Participatory research that used the implementation science framework and the JBI's audit and feedback tools named PACES and GRiP. The study was conducted in a university hospital in southeastern Brazil, with the participation of the multidisciplinary team and managers. The study was organized following the steps: situational diagnosis; protocol development; training; protocol implementation; monitoring and protocol review. Data were analyzed through descriptive statistics and content analysis. Results: Seven audit criteria were listed based on national and international guidelines, WHO and Ministry of Health manuals, and JBI Summaries. These criteria were assessed for compliance with evidence-based best practices. In the baseline audit, three of these criteria were found to be compliant, while the other four were non-compliant. Based on the situational diagnosis and baseline audit, barriers were identified, and eleven strategies were developed with the resources described for their execution. After the training, all the audited criteria showed compliance in the first follow-up audit, and five out of the seven audited criteria were compliant in the second follow-up audit. Products: Protocol for breastfeeding premature and low birth weight newborns. Flowcharts, process mappings, and infographics to guide staff work and parents' involvement in this process. Multidisciplinary and intersectoral training. Final Considerations: This project achieved the goal of improving evidence-based practice among the multidisciplinary team and enabled the development and implementation of the institution's first protocol for breastfeeding assistance to premature and low birth weight newborns, facilitated by the implementation of multifaceted strategies targeted at
the identified barriers. The protocol and products are already implemented and generating positive impacts in the institution. This research has the potential to be applied at the regional and national levels as it systematically describes an innovative method with the necessary steps and resources for the implementation of the best scientific evidence. The research influenced changes in practice, but the maintenance of evidence-based care and adherence to the protocol require ongoing education for the neonatal team and other involved sectors to achieve better results.

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