Presented To
Hospital Breastfeeding Council of Metro Chicago
January 17, 2012
By
Kimberly Carter, RN, MSN, APN
Northwestern Memorial
Hospital

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Breastfeeding improvements 2009-2012
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Breastfeeding prevalence day
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Breastfeeding model of care
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Breastfeeding data collection sources
• mPINC survey results
•
TJC exclusive breast milk feeding rate

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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
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Enhanced breastfeeding policy by introducing 1 st 12 hour process flow to be consistent with our hypoglycemia policy
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Rolled out new policy to nursing staff in June, 2009
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Produced and rolled out breastfeeding education scripting cards and LATCH score card for nursing staff in December 2010
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Identified a need for data collection related to breastfeeding education and support for our patients
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Started discussion of prevalence day in May 2009 from the concept of skin prevalence day
Northwestern Memorial
Hospital


Breastfeeding survey composed to identify if patients are being adequately supported with breastfeeding

1 st 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

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Developed tool for inpatient NICU mothers and they were interviewed beginning in August, 2011
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Comparison results of postpartum units, NICU mothers, and
1 st time mothers
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Since October 2009, 369 patients have been surveyed
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Hosted first annual breastfeeding conference in June 2011-
“Breastfeeding and Evidence Based Practice: Bringing
Knowledge to the Bedside”-135 attendees were present
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July 2011, began partnership with Healthy Places
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Healthy Places contract signed and CEO letter obtained in
January 2012
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Completed policy review with BFUSA in January 2012
Northwestern Memorial
Hospital

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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
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Assistance, observation, and support of staff while breastfeeding

Formula supplementation and reasons for supplement
Northwestern Memorial
Hospital

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Recognition of infant feeding cues, proper latch, and output
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Educational materials received/interactive TV education
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Follow up resources given

Advice from nurse and physician about breastfeeding
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If newborn was taken to the nursery during the night and if baby was brought out for feeds
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Pain with breastfeeding

Preparation to breastfeed at home
Northwestern Memorial
Hospital

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A better defined model for breastfeeding mothers was implemented January 2011
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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

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
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
PCT
• Support couplet as part of the team
• No bottles unless requested by mother and documented
• Accountable for pt satisfaction
Mom-Baby
Couplet
Northwestern Memorial
Hospital
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

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Electronic breastfeeding documentation:
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Nurse documents feeding choice in patient profile upon admission
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Nurse documents LATCH in newborn I&O record
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Nurse weighs newborn daily after 10pm and weight loss calculation is completed – if loss is high, encourage more breastfeeding
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Nurse enters order for an LC consult if needed
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Nurse encourages patient to document feedings on white board in room or on feeding log (this is not electronic)
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Prevalence day (Quarterly)
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TJC exclusive breast milk feeding rate (Monthly)
• mPINC Survey (Every 2 years)
Northwestern Memorial
Hospital

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Patients have routine infant procedures performed while mother and infant are skin to skin? (Most) >90%
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Skin to skin contact after vaginal delivery? (Most) >90%
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Percentage of patients have the opportunity to breastfeed within 1 hour of uncomplicated vaginal birth? (Most) >90%
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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

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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.”
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If your average monthly patient sample group size (N) is >=
181, minimum required sampling group is 37
Northwestern Memorial
Hospital

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UHC provides us with a sample size of cases to review each month for 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.
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9/2010 – 30%
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10/2010 – 39%
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11/2010 – 35%
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12/2010 – 29%
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1/2011 – 33%
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2/2011 – 39%
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3/2011 – 49%
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4/2011 – 37%
5/2011 – 31%
6/2011 – 48%
7/2011 – 34%
8/2011 – 26%
9/2011 – 34%
10/2011 – 24%
11/2011 – 34%
12/2011 - TBD
Northwestern Memorial
Hospital


Preserve opportunity to breastfeed within 1 hour for an uncomplicated vaginal birth and 2 hours for an uncomplicated c-section birth
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Continue and promote skin to skin contact in the NICU, L&D, and postpartum units
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Further reduce percentage of breastfeeding infants receiving non-breast milk feedings
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Continue to promote and increase rooming-in
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Develop defined model of lactation support for the NICU
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Maintain and increase breastfeeding education for MB, L&D, and NICU nurses, and pediatric residents and attendings
Northwestern Memorial
Hospital

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Establish consistent breastfeeding education for OB/Gyn residents and attendings
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Continue to present breastfeeding data at the OB/Peds QM meeting (Quarterly)
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Continue to present breastfeeding data at the OB/NICU/Peds
Operational meetings (Monthly)
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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