Utah Milk Bank Survey

The feasibility of establishing a human milk bank in Utah is being evaluated. We would appreciate your input to assess current attitudes and practices. The following survey should take just a few minutes to complete and will provide valuable information. You may remain anonymous, or provide personal information which will not be shared outside of the Milk Bank Task Force. Results of this survey may be obtained by contacting the Utah Breastfeeding Coalition (milkbank@utahbreastfeeding.org). Thank you in advance for your time and interest.

1. In my work environment, I: (select all that apply and fill in the blanks)
  see need for use of donor milk (the need is there or it is not)
  suggest donor milk to (number of patients/consumers) per year
  have prescription privileges for donor milk
  prescribed donor milk to (number of patients/consumers) in the last 6 months
  have prescribed donor milk for years
  discuss donor milk and milk banking during in-services, grand rounds, or other groups (e.g., La Leche League meetings) to (number of attendees) per year
       
2. Yes: No:  
  I see a demand for prescriptions for donor milk
       
3. Yes: No:  
  I get reimbursement for donor milk
  How much? $/ounce
$/100 ml
other (list)
  From whom? BC/BS
IHC
Others (list)
       
4. Yes: No: I agree that a milk bank in Utah: (answer all)
  is needed to ensure the health of Utah's children
  is redundant since Utah's human milk need is sufficiently met by Denver
  would need to be not-for-profit to be successful
 

could be supplied solely by volunteer donors (lactating mothers) in Utah
       
5. I believe my hospital or clinic would be interested in being a: (select all that apply)
  distribution site for donor milk
  collection site for donor milk
  storage site for donor milk
  processing center for donor milk
       
  Yes: No:  
6. I am interested in joining the Utah Breastfeeding Coalition’s Milk Bank Task Force
     

I will bring the following knowledge/experience/expertise to the group:
       
  Yes: No:  
7. I know of resources (e.g., lab space, grant funding, promotion, health professional) that would be helpful in assessing the feasibility and starting up a milk bank in Utah.
     

Please describe briefly:
   
8. Additional Comments
 
       
Affliation/Organization/Hospital:
Department:
Name, Credentials (IBCLC, RN, RD, MD, PT, mother-to-mother counselor, other):
Email:
Phone:
Government clinic affiliations (e.g., WIC):
       
       

Thank you for your time and interest in Utah Milk Banking.