BREASTFEEDING PERFORMANCE IMPROVEMENT

Using data to drive practiceKaren Callahan, MSN RNDirector Maternal Child ServicesPalos Community Hospital

• 26 bed LDRP Unit• Level 2 ICN• 1200 births per year• 2.5 FTE Lactation Consultants IBCLC• 4 new CLCs working 3p-7a• Nursing Moms Network Breastfeeding Support Group• Pump Rental & Lactation Boutique• Centricity Perinatal for L & D charting• Meditech for Post partum and Newborn charting

Palos Community HospitalPalos Community Hospital

Timeline Breastfeeding PI Project2010-2011

Exclusive breastfeeding TJC Core Measure• Actions: The exclusive breast feeding core measure

from the Joint Commission added as a quality indicator for MCH nursing and Pediatric medical PI.

• Newborn feeding methods were developed in Meditech Patient Care System (PCS).

• Newborn standing orders were revised to include reasons for supplementation.

• Exclusive breastfeeding core measure is monitored monthly by the Quality Analyst and Lactation Consultants monthly.

• Nursing outlier cases are peer reviewed by the Unit Based Practice Council.

Timeline Breastfeeding PI Project mPINC Survey Results returned

Action Plan developed• Skin to skin contact and initial breast feeding

within 1 hour of vaginal birth and within 2 hours of c-section.

• The golden hour initiative implemented December 2010 for initiation of breastfeeding and skin to skin contact. Within 1 hour of a vaginal delivery and 2 hours of a c- section, skin to skin contact for 30 minutes. Skin to skin becomes standard of practice.

GE Centricity PerinatalLabor & Delivery Summary

• Feeding preference documented Breastmilk Formula Pump Undecided• Golden Hour Initiative Skin to skin 30 minutes within 1 hr of vaginal delivery Skin to skin 30 minutes within 2 hrs of C-Section Initiate Breastfeeding within 1st hr post delivery

Meditech Assessments

Meditech EMR

Meditech Assessments

Meditech Assessments

Breastfeeding Rates at PCH

Years 2000-2010

MONTHLY STATISTICSDec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Jul-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

TOTALS

NEWBORN ADMISSIONS* 72 87 97 90 79 111 112 109 120 89 98 83 1147

IDENTIFIED BREASTFED NEWBORNS 48 74 73 75 58 85 84 82 95 75 73 63 885

EXCLUSIVELY BREASTFED 16 22 23 30 22 32 38 38 35 32 39 31 358

% OF EXCLUSIVELY BREASTFED 33% 30% 32% 40% 38% 38% 45% 46% 37% 43% 53% 49% 40%

DOCUMENTED REASONS FOR NOT EXCLUSIVELY BREAST FEEDING

<37 Completed weeks of gestation 2 0 0 0 0 1 0 2 3 0 0 0 8

Discharge from the hospital while in SCN 1 1 1 2 1 3 1 0 1 0 0 2 13

Dehydration/10% Weight loss 4 1 0 2 6 5 5 6 6 6 7 9 57

Patient Request 14 23 2920

16 37 25 28 40 29 21 12 294

Other Documented Reason for Not Exclusively Feeding Breast Milk 5 17 13

16 12 7 14 5 7 6 3 9 114

REASONS FOR OPPORTUNITY FOR IMPROVEMENT

Mother Requested Supplementation & No Physician Order 2 4 5 3 0 0 0 2 2 1 0 0 19

No Physician Order for Supplementation 4 6 2 2 1 0 1 1 1 1 3 0 22

0

0

0

                             

Exclusive Breastfeeding at Discharge 12/2010-11/2011

3330 32

40 38 38

45 46

3743

5349

0

10

20

30

40

50

60

Dec Jan Feb Mar Apr May Jun Jly Aug Sep Oct Nov

Month

Perc

ent E

xclu

sive

ly B

reas

tfed

% Exclusively Breastfed

HP 2020 Goal

Linear (% ExclusivelyBreastfed)

Percent reason for not Exclusively Breastfeeding 12/2010 - 11/2011

2 312

60

23

010203040506070

< 37 weeksgestation

Dischargefrom the

hospital whilein ICN

Dehydration/10% Weight

loss

PatientRequest

OtherReasons

Reason

Perc

ent

Percent

Multidisciplinary Breastfeeding Committee

Committee will revise policy to include elements of breastfeeding practice identified by mPINC. Address Baby Friendly breastfeeding initiation, continuation and exclusivity strategies.

Task force members include representation from: MCH Nursing, OB, Pediatrics, Neonatology, Nursing Administration, Lactation and Quality Improvement.

What Can We Do To Make a Difference?

Palos is in the Rush Perinatal Network

The Rush Perinatal Network has established minimum standards for breastfeeding practice and a timeline for 2012

The Multidisciplinary committee will operationalize the minimum standards

Network Minimum Standards for Breastfeeding Care

• Provide Skin to Skin Contact for at least 30 minutes to all patients without complications regardless of feeding method within 2 hours of delivery

• Initiate breastfeeding within 60 minutes for all uncomplicated vaginal and cesarean births

• Promote 24 hour rooming in to keep mothers and babies together unless medically indicated

• Facilitate breastfeeding on demand

Network Minimum Standards for Breastfeeding Care

• Educate and promote patients and families on the benefits of exclusive breastfeeding

• Support exclusive breastfeeding by avoiding the use of routine supplementation of breastfeeding infants through the use of formula, glucose, or water unless medically indicated.

• For mothers who are separated from their babies educate and initiate breast pumping as soon as possible post delivery or within 6 hrs

EBBHI Project TimelineEBBHI Project Timeline20122012

Complete Network Breastfeeding Practice Survey 1st Quarter Hospitals Identify Champions Create a breastfeeding committee Complete Baby Friendly Assessment Report Baseline Quality Outcomes Report Status

2nd Quarter Create a workplan Breastfeeding policy development/revision Report Status

EBBHI Project TimelineEBBHI Project Timeline20122012

3rd Quarter Implement workplan Educate staff and providers Report Status

4th Quarter Report Monthly Quality Outcomes Complete Network Breastfeeding Practice Survey Report Status

Next Steps

Revise breastfeeding policy Develop role of CLC Implement skin to skin for

c-section patients in OR Champions to attend HC One Rush Training Feb 16, 2012

Questions?