INTRODUCTION: After attending an evidence-based seminar, 2 staff nurses acknowledged inconsistencies in the current feeding practice and also that physicians' orders varied regarding when to start bottle-feedings and how often to bottle-feed. This led them to further investigate enhanced feeding techniques for premature infants. The investigators used latest evidence to develop and implement a standard feeding program for the staff and then evaluated retention. The program emphasized infant readiness, consistent oral feeding techniques, a common language between caregivers, and instructions for parents.

METHODS: The staff's baseline knowledge of the premature infant's readiness to feed and current feeding practice was evaluated by using a validated oral feeding survey. Results of the survey were used to structure evidence-based education. Staff understanding was evaluated at the time of structuring evidence-based education and 6 months afterward. Descriptive analysis was used.

RESULTS: Participants included 117 nurses, 18 patient care assistants, and 7 neonatologists. Findings showed that 41% of the staff members were not assessing for signs of feeding readiness but were using gestational age or other indicators before feeding. The behavioral characteristic reported as used "almost all the time" by 59% of the nurses was observed sucking. Pretest and posttest scores around the mandatory education showed an average pretest score of 67.6% and an average posttest score of 93%. Retention after 6 months showed an average score of 88.8%.

CONCLUSIONS: The new feeding protocol includes a physician's order that reads "nipple per feeding readiness" allowing autonomy for the nurse. The retention score demonstrates maintenance of the education provided. Staff nurses drove the implementation of this practice change that led to improved understanding and use of evidence to support practice.