What’s In A Label?

The answer should be everything. Everything that is needed to complete one’s feeding task safely and timely. But how can all the information that is recommended live ON a bottle label?

Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities 3rd Edition (by the Academy of Nutrition and Dietetics), is also known as the ‘blue book‘, and it recommends that labels include the following: 

  • Patient name
  • MRN/account number
  • Contents plus additives
  • Caloric density
  • Volume in container
  • Expiration date & time
  • Volume & frequency
  • Route of administration
  • For enteral use only
  • Thaw date, time & expiration of original label
  • Initials of preparer(s)

That is a lot of information to be written or printed on a label. To be read thoroughly, transcribed completely, and updated accurately as bottle contents are changed and move from one container to another. That does not happen, because it’s too much.

Here is what most hospitals stick to: “Each bottle must be clearly labeled with the patient’s full name and the date that the milk was expressed. If human milk was previously frozen, the label should also indicate the date milk was thawed.”

But what good is the “date that the milk was expressed” if it’s been fortified, or combined with more bottles? If the bottle contains thawed milk, which cannot be refrozen, does it need a new label? A label with a different color? Or a colored sticker added to the original label? Isn’t each time a bottle is re-labelled a potential failure point? Don’t stickers fall off sometimes?

Having staff memorize more rules and exceptions is not the right strategy. How do you make the safest process also the easiest process? To finally eliminate workarounds, deviations, and errors.

What if that data lived IN a label? 

Then staff would not be recording, updating, and transcribing all of that information. This is the Keriton difference.

The ‘blue book’ rules and validations are gospel. So we coded them into Keriton’s software. They are enforced through human-centric design and automation. The current process was not just digitized: true quality improvement methodology is applied to every single step of the process. Keriton was designed by nurses, lactation consultants, dietitians, and moms. Our co-innovation with the end-users shows in how well the final product works. The single source of truth … the label. 

The average milk preparation and feeding process involves 32 critical failure modes that require human detection to prevent error. Infant feeding management is extremely complicated, if not one of the most complicated processes at a hospital, let alone the NICU. Period. 

Change is Hard

Change management focuses on people’s reactions to change processes, and tools. An essential part of organizational change management is not only managing all the moving parts but also understanding how people process change. The new Keriton paradigm is the biggest change management hurdle our customers face — moving from the physical bottle label to the virtual one. After partnering with hospitals that manage milk in many different ways, Keriton has the experience to assist with change management every step of the way.    

The process was … a process. Just learning the new workflow. But I think people became early adopters and the buy-in was pretty high.

Nurse Educator

Maternal Supply Management 

When you have to know, how do you know? Maybe it is during rounds when a physician asks, “Is mom still pumping? How much is at home, and how much do we have here?” Or the Nutrition Lab needs to decide which feed order to advance, and if there is enough maternal milk for a 12 hour prep. There are many scenarios. Either way, you need to know so you do not have to guess.

When a mom asks how much milk we have, fresh vs frozen, etc., instead of having to walk over to where the milk is and count, we can show her or she can see for herself in the app.

– NICU Nurse
Clinical Dietitians and Lactation Consultants can see mom’s pumping metrics by volume, bottles and sessions, anytime. Mom can see her metrics too and use it as motivation to keep up her routine.

Recipe & Expiration Calculations 

All recipes and expirations are calculated in the application, and that information is maintained on the virtual bottle label within the system. No need to reprint the label at every state, contents, and expiration change. This reduces both time spent and consumables used, not to mention all the opportunities for errors that relabeling brings. The bottle history information, the who, what, when, and where, are always available digitally and you no longer have to peel back labels to see the previous steps.  

It was initially nerve racking having to trust an app to calculate everything correctly. Now it’s so awesome not having to figure out the math of expiration date/time. It is a total time saver and we are confident that things are correct.

– Milk Room Manager
Staff can see the latest feed order from the EMR with the recipe calculations, to prepare the feed. Nurses can see exactly which bottle number to feed, as well as its expiration and location.

Inventory Management 

Instead of rummaging through bins to find the next bottle to use, whether by fortification or expiration, nurses can simply check the virtual bin and select the bottles they want to use. The system catches and prevents errors at every step, without 2-persons checks and without relabeling. Managers and admins can check the auto-audits and auto-logs for every action, preventing workarounds altogether. 

The amount of time saved not having to figure out expiration date/time, as well as when you’re ready to feed, not having to look at every bottle for the date/time (just having to look for a bottle number) is very valuable.

– Nurse Manager


Up until now, we did not truly have an option to ensure the safety of every single step of the feeding management process, starting with the mom and ending at feeding the patient. Changes with modern technologies like Keriton Kare allow for a truly automated and efficient feeding management experience and much more. The platform automates all of the failure points throughout the process and actually prevents errors from occurring by highlighting the potential to the end user BEFORE it takes place. (All prevented errors are captured by the system and reported on real-time as well as weekly/monthly in aggregate.)

The Keriton platform meets a hospital’s requirement from every aspect – safety, efficiency, transparency, complex workflow management, reporting, and auditing. Multiple Keriton customers have been reviewed by the Joint Commission while Keriton Kare was being utilized.  The platform not only meets the requirements of the ‘blue book’ but far exceeds them with the examples cited above. 

Get in touch and we’ll show you how it works.