CLE Protocol Development & Review 3 — Questions and Answers
Question 1: A CLE is creating a protocol for managing hypoglycemia in breastfed newborns. Which intervention should the protocol include BEFORE recommending formula supplementation?
- Blood glucose monitoring every 15 minutes
- Frequent breastfeeding or expressed colostrum feeds (Correct answer)
- Intravenous dextrose administration
- Separation of mother and baby for observation
Correct answer: Frequent breastfeeding or expressed colostrum feeds
Per evidence-based guidelines, frequent breastfeeding and expressed colostrum are recommended first-line management for mild neonatal hypoglycemia before formula supplementation.
Question 2: When a breastfeeding protocol is implemented in a new unit, the MOST effective training method is:
- Distributing written copies only
- Competency-based staff education with return demonstration (Correct answer)
- A single mandatory lecture
- Sending a protocol link via email
Correct answer: Competency-based staff education with return demonstration
Competency-based education with return demonstration ensures staff can correctly apply the protocol steps, not just recall information.
Question 3: A protocol for breast pump use in the NICU should specify minimum pumping frequency for establishing full milk supply as:
- 2-3 times per day
- 4-5 times per day
- 8-12 times per 24 hours (Correct answer)
- Once per shift
Correct answer: 8-12 times per 24 hours
Research supports that mothers of NICU infants should pump 8-12 times per 24 hours, mirroring newborn feeding frequency, to establish and maintain full milk supply.
Question 4: In a protocol review process, 'stakeholder input' most appropriately refers to:
- Feedback from equipment vendors only
- Input from all staff and patients affected by the protocol (Correct answer)
- Opinions from hospital administration only
- Reviews from external auditors only
Correct answer: Input from all staff and patients affected by the protocol
Effective protocol development includes input from nurses, physicians, lactation staff, and ideally patients/families who are directly affected by the protocol.
Question 5: A late preterm infant (35-36 weeks) is struggling to breastfeed effectively. Which protocol element is most critical to include for this population?
- Encourage formula introduction at day 2
- Supplement with expressed breast milk if intake is inadequate and monitor weight (Correct answer)
- Advise mother to wait until infant reaches 40 weeks corrected age
- Limit breastfeeding attempts to once per day
Correct answer: Supplement with expressed breast milk if intake is inadequate and monitor weight
Late preterm infants are at high risk for poor intake and jaundice; protocols should address supplementation with expressed breast milk and close weight monitoring.
Question 6: Which metric is most useful for evaluating whether a hospital's breastfeeding protocol is achieving its goals?
- Number of protocol pages
- Exclusive breastfeeding rates at discharge (Correct answer)
- Staff years of experience
- Number of lactation consultants on staff
Correct answer: Exclusive breastfeeding rates at discharge
Exclusive breastfeeding rates at discharge directly reflect whether hospital protocols and practices are supporting breastfeeding initiation and continuation.
Question 7: A CLE reviews a protocol and finds it references a study from 2005 as its sole evidence base. The appropriate action is to:
- Keep it, since older studies are more reliable
- Search for updated systematic reviews and revise references accordingly (Correct answer)
- Add a disclaimer and leave the protocol unchanged
- Remove all references from the protocol
Correct answer: Search for updated systematic reviews and revise references accordingly
Protocols must reflect current best evidence; a CLE should search for updated systematic reviews or meta-analyses and revise the evidence base before the next review cycle.
CLE Protocol Development & Review 3
A CLE is creating a protocol for managing hypoglycemia in breastfed newborns.
Which intervention should the protocol include BEFORE recommending formula supplementation?