Breast milk robot aims to ease the workload on nurses

Tom is 2.10 metres tall and works with the tiniest babies in the Neonatology Department at Erasmus MC Sophia Children’s Hospital. Some are no bigger than his hand. He has just returned from inserting a central venous line with millimetre precision. A speciality he owes mainly to his gaming past, he says with a laugh. “Constantly looking at the monitor whilst my hands were on the controls is now paying off.”

Smart use of technology

At Erasmus MC Sophia Children’s Hospital, Tom has the opportunity to combine his vision for the organization of care with his passion for technology. He’s seizing it with both hands. Because, according to Tom, the smart use of technology is the solution to the nursing shortage – the biggest problem in modern healthcare.

"Because of that shortage, eight incubators in this fully equipped ward are currently empty." He gestures around him. "If we don’t have enough nurses, we have to transfer premature babies to other teaching hospitals, leaving their parents far from home and their social support network. The breast milk robot and other technological developments can change this."

Focus on nurses

The nursing shortage is forcing the Netherlands to organize healthcare differently, Tom explains. "Initially, the focus was solely on the patient – what we call patient-centred care – but nowadays we also focus on the whole family. That was a significant shift, but I am firmly convinced that we must now focus on nurse-centred care."

This gives nurses more time at the bedsideAccording to Tom, healthcare should no longer be organised around demand, but around the available supply. "That is a time-honoured economic principle. Our nurses run themselves ragged all day long. But much of the work they do isn’t part of their core duties.” A breast milk robot can reduce the workload. “This gives our nurses more time to help newborn babies at the start of their lives."

Preparing breast milk is a full-time job

Time is a key factor in caring for newborns. One of the tasks that currently takes up a great deal of nurses’ time is preparing breast milk. Seriously ill or premature babies are usually unable to feed themselves and are fed via a feeding tube. Their own mother’s milk is best for these babies, as they tolerate it better and the risk of infection is lower. If the mother’s milk supply has not yet established itself sufficiently, donor milk is used.

In the Neonatology department alone, two nurses spend four hours every day measuring and dispensing expressed breast milk with millimetre precision. Into syringes for the feeding tubes and bottles for when the premature babies are able to feed themselves. Often supplemented with protein powder. “For one baby, for example, I might prescribe twelve doses of fifteen millilitres a day. Preparing this is labour-intensive work in which, despite great care, mistakes can occur.”

 Watch the video below about the project:

Because in a busy ward, there is a risk that breast milk will be mixed up or that the amount will be incorrect. "Too little milk stunts growth, whilst too much at once can overload the intestines and lead to infections. Mixing them up can spread infections," explains Tom. "It also has major consequences for parents’ trust, including in the rest of the care system. If this goes wrong, how can they trust that their baby is receiving the correct medication? I want to improve these kinds of procedural errors too."

Pieces of the puzzle

Within the Convergence partnership, he therefore invited various disciplines to take a close look at the situation in his department. “I already had the idea of having a robot take over the tasks, but I wanted to know what was technically possible. And everyone had to feel the same sense of urgency.” The responses were promising, and so the healthcare innovation project NEOPERFECT was born.

"We have the best in the field from every discipline. TU Delft provides expertise, guidance and insights in the field of robotics. Erasmus University Rotterdam is researching what our nurses and parents consider important, and we are showing how we currently work and the challenges we face. They are all pieces of the puzzle that come together in the robot we are building."

The needs of all those involved

The wishes of all those involved are taken into account during the design process. “For parents, it is important that breast milk is not mixed up. For doctors, the number of millilitres must be exactly right, and nurses want to be able to see what is happening.” That is why the robot has transparent panels. It must also not make too much noise. “That creates unnecessary stimulation for the babies in the ward.”

This is nurse-led care in practice

So there’s no human involvement whatsoever. After expressing her milk, the mother places her own container of milk into the machine. It automatically prepares the correct amount of feed for her baby. The nurse receives a notification when the feed is ready. “There are no more handover moments, as research by Erasmus University showed that these were a major source of errors. What’s more, the quality of the milk remains better, as temperature fluctuations are reduced and reheating – sometimes even in the microwave – is no longer necessary.”

The project is now on its third prototype. This one can prepare feeds for ten patients over a 48-hour period. This results in a saving of around eight full-time jobs across the various departments in the hospital where breast milk is used. “So less unnecessary labour-intensive work for nurses and more time at the bedside,” emphasises Tom. ‘This is nurse-centred care in practice."

If everything goes according to plan, the breast milk robot will be put into service in 2028 or 2029. "This robot is truly the brainchild of parents, nurses, researchers and technicians who are passionate about children. That provides the energy and momentum you need for projects like this," Tom concludes with a smile. "We can be really proud of that."

Text: Esther Godijn
Photography: Harmen de Jong

Read the original article on Amazing Erasmus MC here (in Dutch): Tom bouwt een moedermelkrobot - Amazing Erasmus MC 

Collaboration for healthcare innovation

The NEOPERFECT milking robot was developed within the Convergence network, in which various organisations are joining forces to promote healthcare innovation. Neollie, Erasmus MC Sophia Children’s Hospital, RoboHouse – TU Delft’s field lab, Erasmus University Rotterdam and Healthy Start are involved in this project. The project receives funding from the WorkTech healthcare innovation program, an initiative of Medical Delta, InnovationQuarter and ZWconnect, co-funded by a PPP grant from Health Holland.