Transcript Breastfeeding Improvements and Data Collection

Breastfeeding Improvements and Data Collection
Strategies
Presented To
Hospital Breastfeeding Council of Metro Chicago
January 17, 2012
By
Kimberly Carter, RN, MSN, APN
Northwestern Memorial
Hospital
Objectives
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Breastfeeding improvements 2009-2012
Breastfeeding prevalence day
Breastfeeding model of care
Breastfeeding data collection sources
mPINC survey results
TJC exclusive breast milk feeding rate
Breastfeeding Improvements 2009-2012
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Breastfeeding Multidisciplinary Committee re-established 2009
Group consisted of APN’s, RN’s from L&D/AP/PP/NICU, LC’s,
BFC’s, EC’s, and MD’s
Enhanced breastfeeding policy by introducing 1st 12 hour
process flow to be consistent with our hypoglycemia policy
Rolled out new policy to nursing staff in June, 2009
Produced and rolled out breastfeeding education scripting cards
and LATCH score card for nursing staff in December 2010
Identified a need for data collection related to breastfeeding
education and support for our patients
Started discussion of prevalence day in May 2009 from the
concept of skin prevalence day
Northwestern Memorial
Hospital
Breastfeeding Improvements (cont)
 Breastfeeding survey composed to identify if patients are being
adequately supported with breastfeeding
 1st prevalence day July 2009 (APNs surveyed only)
 Modified questions after initial survey
 Solicited feedback from CWISH hospitals on surveys October 2009
 First annual “Breastfeeding Prevalence Day” in October 2009 using
modified survey
 Patient survey is performed on a quarterly basis
 Group of APN’s, EC’s, and BFC’s interview mothers on the
postpartum units
Northwestern Memorial
Hospital
Breastfeeding Improvements (cont)
• Developed tool for inpatient NICU mothers and they were
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interviewed beginning in August, 2011
Comparison results of postpartum units, NICU mothers, and
1st time mothers
Since October 2009, 369 patients have been surveyed
Hosted first annual breastfeeding conference in June 2011“Breastfeeding and Evidence Based Practice: Bringing
Knowledge to the Bedside”-135 attendees were present
July 2011, began partnership with Healthy Places
Healthy Places contract signed and CEO letter obtained in
January 2012
Completed policy review with BFUSA in January 2012
Northwestern Memorial
Hospital
Breastfeeding Prevalence Patient Survey
Information
 Patient survey contains many breastfeeding quality measures in
relation to data from the mPINC survey and includes the
following information:
 Location and timing of first breastfeeding
 Skin to skin education and skin to skin contact between
mother and baby
 Assistance, observation, and support of staff while
breastfeeding
 Formula supplementation and reasons for supplement
Northwestern Memorial
Hospital
Breastfeeding Prevalence Patient Survey
Information
 Recognition of infant feeding cues, proper latch, and output
 Educational materials received/interactive TV education
 Follow up resources given
 Advice from nurse and physician about breastfeeding
 If newborn was taken to the nursery during the night and if baby
was brought out for feeds
 Pain with breastfeeding
 Preparation to breastfeed at home
Northwestern Memorial
Hospital
Breastfeeding Model of Care Changes
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A better defined model for breastfeeding mothers
was implemented January 2011
– As a result of our multidisciplinary breastfeeding
committee, work by our graduate student intern program
(August 2010), and results from our breastfeeding data
strategies, changes to our breastfeeding model included
defining the expectations in breastfeeding support of the
bedside nurse, PCT, breastfeeding counselor (BFC), and
lactation consultant (LC).
Northwestern Memorial
Hospital
Model of Breastfeeding Support January 2011
BFC
• The goal is for 8-12 out of
24 hours there will be a BFC
on each PP unit
• See breastfeeding patients
with issues after
communicating with bedside
RN
• If unable to correct issues,
consult LC
• Role model breastfeeding
messaging and behaviors
•Accountable for pt
satisfaction
Lactation
Consultant
Breastfeeding
Counselor
Bedside
Nurse
Mom-Baby
Couplet
PCT
• Support couplet as part of
the team
•No bottles unless requested
by mother and documented
•Accountable for pt
satisfaction
Northwestern Memorial
Hospital
LC
• Consult advanced
breastfeeding issues
• Integrated into unit practice
•Communicate with staff, CC,
and BFC daily
• Available for timely consults
• Accountable for offering
RN/BFC education
• Accountable for pt
satisfaction
Bedside RN
•Primary responder and
educator for mother and
family
• Consult BFC/LC if unable to
resolve issues
• Consistency in messaging to
mother
•Accountable for pt
satisfaction
Breastfeeding Data Sources at NMH
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Electronic breastfeeding documentation:
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Nurse documents feeding choice in patient profile upon admission
Nurse documents LATCH in newborn I&O record
Nurse weighs newborn daily after 10pm and weight loss calculation is
completed – if loss is high, encourage more breastfeeding
Nurse enters order for an LC consult if needed
Nurse encourages patient to document feedings on white board in room or
on feeding log (this is not electronic)
Prevalence day (Quarterly)
TJC exclusive breast milk feeding rate (Monthly)
mPINC Survey (Every 2 years)
Northwestern Memorial
Hospital
Key improvements in mPINC results (2011
survey)
 Patients have routine infant procedures performed while
mother and infant are skin to skin? (Most) >90%
 Skin to skin contact after vaginal delivery? (Most) >90%
 Percentage of patients have the opportunity to breastfeed
within 1 hour of uncomplicated vaginal birth? (Most) >90%
 Percentage of breastfeeding infants receiving non breast milk
feedings? 25%
 How many patients received a directly observed
breastfeeding assessment by facility staff? (Most)>90%
Northwestern Memorial
Hospital
TJC Exclusive Breast Milk Feeding Data
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The Joint Commission defines exclusive breast milk feeding
as: “a newborn receiving only breast milk and no other
liquids or solids except for drops or syrups consisting of
vitamins, minerals, or medicines. Breast milk feeding
includes expressed mother’s milk as well as donor human
milk, both of which may be fed to the infant by means other
than suckling at the breast. While breastfeeding is the goal
for optimal health, it is recognized that human milk provided
indirectly is still superior to alternatives.”
If your average monthly patient sample group size (N) is >=
181, minimum required sampling group is 37
Northwestern Memorial
Hospital
NMH Exclusive Breast Milk Feeding Rate
• UHC provides us with a sample size of cases to review each month for
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the exclusive breastfeeding measure. Due to our volume of deliveries,
we review 37 charts a month. Infants with a stay in the NICU are
excluded.
9/2010 – 30%
5/2011 – 31%
10/2010 – 39%
6/2011 – 48%
11/2010 – 35%
7/2011 – 34%
12/2010 – 29%
8/2011 – 26%
1/2011 – 33%
9/2011 – 34%
2/2011 – 39%
10/2011 – 24%
3/2011 – 49%
11/2011 – 34%
4/2011 – 37%
12/2011 - TBD
Northwestern Memorial
Hospital
Next Steps for Improving Breastfeeding Support
and Data collection
 Preserve opportunity to breastfeed within 1 hour for an
uncomplicated vaginal birth and 2 hours for an
uncomplicated c-section birth
 Continue and promote skin to skin contact in the NICU, L&D,
and postpartum units
 Further reduce percentage of breastfeeding infants receiving
non-breast milk feedings
 Continue to promote and increase rooming-in
 Develop defined model of lactation support for the NICU
 Maintain and increase breastfeeding education for MB, L&D,
and NICU nurses, and pediatric residents and attendings
Northwestern Memorial
Hospital
Next Steps (cont)
 Establish consistent breastfeeding education for OB/Gyn
residents and attendings
 Continue to present breastfeeding data at the OB/Peds QM
meeting (Quarterly)
 Continue to present breastfeeding data at the OB/NICU/Peds
Operational meetings (Monthly)
 Re-establish breastfeeding multidisciplinary committee
meetings including quality leader, NICU dietician, Erie clinic
MD, NICU hospitalist, midwife representative
 Develop and implement documentation for discharge feeding
method
Northwestern Memorial
Hospital