Transcript Breastfeeding Performance Improvement: Using

BREASTFEEDING
PERFORMANCE IMPROVEMENT
Using data to drive practice
Karen Callahan, MSN RN
Director Maternal Child Services
Palos Community Hospital
Palos Community Hospital
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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
Timeline Breastfeeding PI Project
2010-2011
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 Perinatal
Labor & Delivery Summary
• Feeding preference documented
 Breastmilk
 Formula
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Pump
Undecided
• Golden Hour Initiative
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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
Breastfeeding Initiation Rate 2000-2011
85%
Percent Breastfeeding
82%
82%
82%
82%
82%
82%
82%
82%
82%
82%
79%
80%
82%
79%
76%
76%
74%
75%
75%
75%
HealthyPeople 2020 Goal
71%
69%
72%
% breastfeeding
71%
70%
65%
60%
2000-2010
Years 2000-2010
Linear (% breastfeeding)
Dec10
Jan11
Feb11
Mar11
Apr11
May11
Jun11
Jul11
Aug11
Sep11
Oct11
Nov11
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
33%
30%
32%
40%
38%
38%
45%
46%
37%
43%
53%
49%
40%
MONTHLY STATISTICS
% OF EXCLUSIVELY BREASTFED
Dec11
TOTA
LS
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
29
2
0
16
37
25
28
40
29
21
12
Other Documented Reason for Not Exclusively
Feeding Breast Milk
5
17
13
1
6
12
7
14
5
7
6
3
9
114
294
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
Percent Exclusively Breastfed
60
53
50
45 46
40 38 38
40
30
33
49
43
% Exclusively Breastfed
37
HP 2020 Goal
30 32
Linear (% Exclusively
Breastfed)
20
10
0
Dec
Jan
Feb
Mar
Apr
May
Jun
Month
Jly
Aug
Sep
Oct
Nov
Percent
Percent reason for not Exclusively Breastfeeding 12/2010 - 11/2011
70
60
50
40
30
20
10
0
60
23
12
2
< 37 weeks
gestation
3
Discharge Dehydration/
from the 10% Weight
hospital while
loss
in ICN
Reason
Patient
Request
Other
Reasons
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 Timeline
2012
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 Timeline
2012
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?