Feeding is one of the most frequently performed high-risk workflows in the NICU, yet it remains among the least consistently protected by end-to-end safety controls. Medically fragile patients are vulnerable to errors and poor nutrition. Feeding errors often go unreported, and mistakes in management or preparation put infants at risk and distress families. Workarounds quickly become more than one-offs; they become normalized safety gaps that leadership must address.
Hospitals have invested heavily in EHRs for documentation and care coordination, and those systems are essential to modern clinical operations. However, most commercial EHRs were not designed to manage neonatal and pediatric feeding as a comprehensive workflow. When key feeding-management functions aren’t supported, teams must default to paper logs and manual checks.
That gap shows up even in pediatric enteral nutrition outside the NICU. In one children’s hospital quality improvement project, barcode scanning recorded 48,044 ready-to-feed enteral formula attempts and flagged 1,396 near misses (2.9%), averaging 48 prevented wrong-formula events per month (1.6 per day). Complex, high-frequency workflows require guardrails that do not rely on perfect human performance.
NICUs and pediatric environments benefit greatly from dedicated feeding-management systems, scan-centric tools that complement the EHR with multi-point verification, recipe support, inventory governance, and tighter workflow controls.
Feeding Errors Hide in the Handoffs
Feeding workflow risk is not confined to the moment a nurse scans a bottle at the bedside. The risk is distributed across several steps: collection, storage, preparation, handling, and transport. When scanning and verification are limited to administration, earlier mistakes can pass through unnoticed, and errors across other stages may be underreported.
In day-to-day clinical practice, these risks often show up as:
- Interruptions during clinical tasks
- Competing priorities
- A moment of short staffing
- Last-minute order changes
- Bottles placed in the wrong bin
- Labels that are difficult to read
In complex clinical environments, relying on individual vigilance alone is not an adequate safety measure, and informal workarounds should not become the default way risks are managed. Some units attempt to mitigate this risk through two-clinician checks—a well-intentioned approach that can add significant cognitive load to already stretched teams. However, evidence suggests that double checks do not consistently prevent errors and are difficult to perform reliably in fast-paced settings with frequent interruptions.
A feeding-management system changes the safety model by shifting verification upstream, where problems originate. Multi-point barcode scanning at collection, preparation and administration creates layered protections that intercept wrong-product and expired-product errors earlier in the process, rather than only at the final step.
The EHR is Not a Feeding Workflow Engine
EHRs are designed to capture clinical data. They are typically not designed to extract and automate key information from feeding containers in a way that supports real-time validation and reliable documentation. In many situations, EHR scanning can support positive patient identification; however, it does not automatically capture crucial data for feeding safety and governance, such as contents, lot numbers, or caloric density. This leaves staff to document these elements manually, which opens the floodgates for risk.
Cognitive load in the NICU is a safety issue, not merely an efficiency concern. When staff must repeatedly transcribe, interpret, or re-enter critical feeding details, the workflow becomes more fragile. Feeding workflows often rely on manual documentation to bridge gaps between preparation, labeling, inventory, and administration. Manual documentation drives duplicate charting because the same feeding information must be re-entered across multiple tools and records, which increases cognitive load and introduces opportunities for transcription errors and inconsistency.
Labeling is another example. If an electronic system is not capturing feeding management activities end-to-end, the information often gets recorded on paper or handwritten on labels. Handwritten labeling is prone to more errors than standardized printed labels, especially in high-acuity environments. A dedicated system that automates printed labels and ties labeling directly to verified data reduces the chance that a feed is prepared correctly but labeled incorrectly, a mismatch that can have a detrimental ripple effect.
Wasted Milk, Wasted Time, and Avoidable Stress for Families
Feeding management is also resource management, whether it involves human milk or formula. When tracking failures or inventory mismanagement occur, feeds may be discarded. That loss represents time spent pumping, storing, transporting, logging, and searching. Most critically, it can affect the feeding plan for a medically fragile infant. That risk is especially pronounced with human milk, one of the most carefully stewarded resources in neonatal care, but the downstream impact of waste extends across all feeding types in the NICU.
Inventory governance is a practical place where workflow-specific tools often outperform EHR-only workflows. Expiration-based inventory organization supports first-in, first-out use and reduces reliance on paper logs and manual refrigerator checks. It also improves readiness for recalls by capturing and flagging lot numbers.
For families, feeding is not a background process; it is deeply tied to trust, transparency, and a sense of participation in care. Feeding errors can undermine confidence in the care team and cause significant emotional distress. When parents are already navigating fear, uncertainty, and separation, feeding is one area where they should expect the system to be precise.
If We’re Serious About Feeding Safety, the Standard Has to Change
“Feeding-management system” can sound like a broad label. The standard should be simpler. If the feeding process is treated as a medication-like workflow in the NICU, it should be supported by medication-like safeguards throughout the entire chain. That means multi-point verification that confirms the milk or formula matches the patient, aligns with the current order, is not expired across all handling phases, and captures lot numbers when recall readiness is a concern. Simply waiting until administration catches a mismatch is reactive damage control, not proactive safety design.
It also means the workflow cannot rely on fragile dependencies. This includes assuming consistently clear and standardized orders; expecting manual recipe calculations—including additive displacement factors—to be performed accurately without adding ongoing maintenance burden; or relying on informal inventory practices rather than governed, first-in/first-out processes with measurable stewardship. Documentation should be a natural byproduct of verified steps—accurate, timely, non-duplicative—and capable of flowing seamlessly into the clinical record.
It also means the workflow can’t depend on fragile steps, such as clear, standardized orders; reliable recipe calculations that reduce manual math (including additive displacement factors) without creating an ongoing maintenance burden; and inventory governance that supports first-in, first-out use and measurable stewardship. Documentation should follow naturally from verified steps and be accurate, timely, and non-duplicative, with the ability to flow seamlessly into the clinical record.
It also means the workflow cannot rely on fragile dependencies. This includes assuming consistently clear and standardized orders; expecting manual recipe calculations—including additive displacement factors—to be performed accurately without adding ongoing maintenance burden; or relying on informal inventory practices rather than governed, first-in/first-out processes with measurable stewardship. Documentation should be a natural byproduct of verified steps—accurate, timely, non-duplicative—and capable of flowing seamlessly into the clinical record.
Family-centered care should be supported within the same system reality, with models that can extend visibility across hospital and home inventories, helping parents stay aligned with milk supply needs without shifting clinical responsibility away from the care team.
A Safety Gap Worth Closing Now
NICU leaders don’t need more technology for technology’s sake. They need fewer workflow gaps in one of the highest-frequency, highest-risk processes in neonatal and pediatric care. When a system relies on paper logs, handwritten labels, manual calculations, and bedside-only scanning, it places too much responsibility on individuals and too little on the workflow itself.
To raise the bar for feeding safety, NICU leaders must implement dedicated feeding-management systems that cover the full workflow (preparation, labeling, inventory, and verification) prior to administration. NICUs need to move beyond reliance on fragmented, manual processes and EHR limitations and invest in purpose-built safety systems that reduce errors, documentation burden, and family distress.
Technology can’t replace the relationship between families and clinicians, but it can remove avoidable points of failure that strain that relationship.
About Olivia Jones, BSN, RN
Olivia is a MilkTracker Clinical Sales Specialist. She combines her medical expertise with a dedication to cutting-edge technology to support hospitals in evaluating feeding management software. Before joining AngelEye in 2022, she worked as a NICU nurse at the University of Kentucky and Monroe Carell Jr. Children’s Hospital at Vanderbilt. Her experience as a NICU nurse allowed her to understand the critical importance of accurate and safe feeding practices in neonatal and pediatric environments.
About Jakayla Maher, BSN, RN, RNC-NIC
As a Clinical Specialist for MilkTracker, Jakayla oversees the implementation and support of AngelEye’s MilkTracker solution. She joined AngelEye in 2023 and brings a deep passion for the Neonatal ICU and family-centered care from her nursing career at facilities in Washington, DC, and Colorado. She brings diverse healthcare experience in addition to nursing, having worked on EHR implementation, coordinated hospital mergers, and focused on nursing happiness and efficiency.
