1. Welcome Breastfeeding Teams!
Learning Session 2
Team Breakout #1
90 Day Aim Share and PDSA Presentations

2. Welcome to our topic breakout room!
Welcome and Orientation to Our Breakout
Welcome to our topic breakout room!
Review of our room layout- M. Mackrain
Chat box
Timer
Note Pod

3. Your Hosts Joanne Martin-Faculty Keri Lemoine- Room Monitor
Mary Mackrain- Project Director

4. Round Robin Roll Call: Teams, State Leads, National TA and Staff, Model Developers
NAME
STATE
ROLE
Susan Zaid
DOHVE
Joanne Martin
Faculty
Rhode Island-BF RI
State QI
All LIAs
Kenosha County DH WI
LIA
East Bay CAP
Northeast Florida FL
Carol Brady (state)
Meeting Street
Bradford, Sullivan and Tioga Counties PA
Erie Family Center
Allegheny County HD
Children's Friend
South County Home Health
Comprehensive CAP
Andrew Dietz

5. Objectives for This Breakout
Celebrate progress, focus on what we’ve learned in the first 90 days and best PDSAs to steal
Teams leave with a plan for improvement (Aims & PDSA tests) for the next 90 days in AP2 and new resources to use in their improvement work
5 Minutes per team to share the highlights of your best testing (we will give 2 and 1 minute warnings in the chat box)

6. Our Presentation Roster
Part 1
Bradford, Sullivan & Tioga Counties (PD1)
Meeting Street (PD1)
Kenosha (PD1)
Northeast Florida (PD1)
Part 2
South County Home Health (PD2)
East Bay (PD4)
Comprehensive CAP (PD4)
Allegheny County Health Dept. (PD5)
Children’s Friend (PD5)

7. Our Theory to Reach our SMART AIM

8. Primary Driver 1:
Reliable and effective policies and practices supporting families through critical windows for breastfeeding decision-making.
Bradford, Sullivan and Tioga Counties- Self-Efficacy Scale
Meeting Street- BF Guide and tracking form
Kenosha- Hospital reminder card
NE Florida- 36 week check on intent and infant feeding plan completion

9. How are we doing? Team Pre-work Self Report
*6 out of 10 teams completed survey
Team Pre-work Self Report
How are we doing?

10. NFP Bradford, Sullivan, and Tioga Counties
Breastfeeding
NFP Bradford, Sullivan, and Tioga Counties
Be creative with your team photo and show your team’s personality!
The knowledge our mothers already have about breastfeeding

11. changes your are testing to achieve this 90 day goal
By Feb 2, 3 of NHVs will use self-efficacy scale to increase clients’ intention to bf from not sure to completely sure in 4 of 7 expectant mothers by 36 weeks.
SMART Aim: By Feb 2, 3 of NHVs will use self-efficacy scale to increase
clients’ intention to bf from not sure to completely sure in 4 of 7
expectant mothers by 36 weeks.
Intention to Breastfeed at enrollment & intention to Breastfeed at 36 weeks among the 7 prenatal clients currently enrolled and their answers on the self-efficacy at 36 weeks demonstrates an increase in knowledge
intention at 36 weeks will increase the likelihood that a pregnant women will initiate breastfeeding upon birth
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

12. Ramp of PDSA Cycles: [Use of Self-Efficacy Scale to direct teaching]
Cycle 4 – complete self-efficacy scales with 4 of the pregnant moms who have yet to reach 36 weeks
Cycle 3 – re-test used adapted 13 question self-efficacy scale 2 NHV’s and 2 clients. December 2015.
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
Cycle 2 – expand test but adapted scale to 20 questions used with 3 NHV’s and 3 clients (1 client each) December Made adaptions.
Cycle 1 – use an existing 28 question self-efficacy scale to identify client’s existing breastfeeding knowledge – 1 NHV with 2 clients Nov 25, Made adaptions to scale.

13. Our Annotated Run Chart
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.

14. Our Tools/Tips

15. Team Presentation Meeting Street
We are most proud of including our entire HFA team in our CoIIN practices and getting their input on PDSA’s we are trialing

16. 90 Day AIM Statement: By February 2, 2016, the Meeting Street team will increase the percentage of BF conversations that are had relative to the identified eligible critical windows from 92% to 100% and increase the percentage of formalized conversations from 36% to 90% of eligible critical windows.
Team 90 day goal to lead to achieving collaborative aims (how much, by when and for whom): By February 2, 2016, the Meeting Street team will increase the percentage of BF conversations that are had relative to the identified eligible critical windows from 92% to 100% and increase the percentage of formalized conversations from 36% to 90% of eligible critical windows.
Identify appropriate indicator(s) (in addition to HV-CoIIN measures):
Qualitative feedback by HV’s and CLC’s regarding Feeding Plan development with a family ( Who develops plan with family).
Utilizing Critical Window Tracking Sheet to document the percentage of formalized conversations had.
Qualitative feedback by HV’s about Conversation Tool Guide (Using MI session and techniques to gage and discuss adaptations and effectiveness)
Changes being tested to meet 90 day goals & collaborative aims:
Before/After Survey during our Breastfeeding Brunch to assess a efficacy
A conversational “tool guide” to help home visitors have formalized conversations at the identified critical windows for breastfeeding.
Utilizing Motivational Interviewing to build self efficacy in home visitors to have feeding conversations once formalized
Utilizing Feeding plans with families and deciding whether the CLC or the home visitor should complete the plan with a family
Training Home Visiting team in utilizing the Feeding Plan

17. Ramp of PDSA Cycles: Conversation Tool Guide
Implement:.
Cycle 4: TBD
Cycles 3: Test with 3 HV’s to utilize tool guide with families. Starting Feb 9, 2016 after MI session.
Cycle 2: Presented conversation guide to HFA team and utilized MI training session to discuss adaptations and gage effectiveness. Feb 9,2016.
Cycle 1: CoIIN team develops conversation guide with 2 HV’s to provide prompts for formalized conversations at critical windows.

18. Our Annotated Run Chart
This is something we used additionally to help track formalized conversations at critical windows and we will be looking closely at this data. We expect that the data for February will go up as we completed 3 feeding plans so far however we don’t have the data yet for the amount of prenatal moms for the denominator.

19. Our Tools/Tips- Conversation Tool Guide

20. Breastfeeding Brunch Survey

21. Critical Window Tracking Sheet

22. Kenosha County Division of Health
Be creative with your team photo and show your team’s personality!
Gwen Lori Carrie Briana Molly Betsi
Clients are contacting their home visitor sooner after the birth of their baby so the HV can support them with BF & infant feeding

23. changes your are testing to achieve this 90 day goal
50% of the clients who deliver between 11/5/15 and 2/2/16 will contact their home visitor or KCDOH CLC within 48 hours after the birth of their child
Decrease the lag time between the birth of their baby and contacting the home visitor
Clients will contact their HV shortly after the birth of their child
Develop a card that the HV can give to the client at approximately 36 weeks that gives HV & IBCLC/CLC contact #s. The HV discusses with the client the value of contacting them as soon as possible after the birth of the baby, so that the HV can support them with their newborn/infant feeding
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

24. Developing a card (called the ‘hospital card’) reminding client to contact their HV as soon as possible after the birth of their child so that the HV can provide support of the client, their baby , & infant feeding.
1/31/16 All HVs aware of card, 50% of clients rec’d card, 100% contacted the HVs.
12/31/15 3 HVs using card, 75% of clients rec’d card , no client took card to hospital, 75% contacted HV.
12/15/15 Revamp tracking tool to capture lag time between birth of child and HV contact.
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
12/8/15 Reviewed use & purpose of the card with HVs and asked for HVs to use with soon-to-deliver clients.
11/15/15 Develop hospital card & revise. No HV used it in November as all clients delivered early.

25. Lag time between baby’s birth and contacting home visitor
Goal met
14 d
4 d
2.3 d
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.
# babies

26. Our Tools/Tips
Front & back of hospital card

27. Front & back of BF tracking tool

28. Northeast Florida Healthy Start Coalition NFP Team Presentation

29. SMART AIM: By February 2nd, 2016 we will increase our breastfeeding initiation rate of women with intention to breastfeed from 49% to 70%.
To test multiple proposed changes to increase our breastfeeding initiation rate of women with intention to breastfeed from 49% to 70% by February 2nd, 2016
We will measure: N of pregnant women who report intention to breastfeed at enrollment and at 36 weeks gestation or more; N of women who have infant feeding plan with written goals; N of women who received professional support; and N of women who initiated breastfeeding at delivery.
Nurse home visitors will provide breastfeeding education to all pregnant women at enrollment and at 36 weeks gestation or more, identify those with intention to breastfeed and encourage the completion of an infant feeding plan with written goals before delivery, identify women who need peer counselor or professional breastfeeding (IBCLC) support, and identify women who initiate breastfeeding at delivery.
They answered the 3 questions from the model for improvement

30. Breastfeeding: PDSA Cycles
Cycle 4: How many women
with intention to breastfeed initiated breastfeeding?
11 out of 14 women 78%
Cycle 3: Verify how many women with intention to breastfeed at 36 weeks or more were contacted by IBCLC:
1 out of 7 women 14%
Cycle 2: Verify how many women who reported intention to breastfeed at 36 weeks or more have an infant feeding plan and written goals. Study revealed 100%
Cycle 1: Verify how many women at enrollment and at 36 weeks or more who have the intention to breastfeed. 100% reported intention to breastfeed.

31. What We Have Learned
The nurse home visitors provided breastfeeding education to 26 pregnant women; 24 women reported intention breastfeed while 2 women had no desire to breastfeed; 6 women are 36 weeks gestation or more. 100% of the women at 36 weeks or more reported intention to breastfeed.
8 out of 8 (100%) women with intention to breastfeed at 36 weeks gestation or more have an infant feeding plan with written goals before delivery.
Only 1 out of 7 (14%) women at 36 weeks gestation or more was identified with the need for professional breastfeeding support (IBCLC) and she received a phone contact from IBCLC. However, a NHV referred a new mom who has initiated breastfeeding to IBCLC and home visit was conducted by IBCLC.
11 out of 14 (78%) women with intention to breastfeed at enrollment and 36 weeks or more, initiated breastfeeding at delivery; 2 did not initiate breastfeeding (1 contraindication and 1 changed her mind); 1 was discharged from the program before delivery. This data represent total deliveries in the 1st 90 days.
Providing breastfeeding education at enrollment provides pregnant women the opportunity to learn about breastmilk and its advantages. Breastfeeding education at 36 weeks or more reinstate interest and promote intention to breastfeed.
Infant feeding plan and written goals assist pregnant women to plan ahead like keeping a journal.
Nurse home visitors with breastfeeding education impact their clients with adequate knowledge that influence the intention to breastfeed.
The provision of adequate information and guidance in decision making are essential in breastfeeding.

32. Breastfeeding Tools/Tips
Tools NFP breastfeeding facilitator. Comparison of breast milk and formula (see next slide) Infant feeding tool kit Excel spread sheet to track pregnant women with intention to breastfeed at enrollment, 36 weeks or more, and have an infant feeding plan with written goals. Include women who need professional support and women who initiate breastfeeding at delivery. Tips Provide breastfeeding education on enrollment and verify intention to breastfeed. Provide breastfeeding education at 36 weeks or more and verify intention to breastfeed. Encourage completion of an infant plan with written goals at 36 weeks or more before delivery. Identify women with need for breastfeeding support. Monitor women with intention to breastfeed at 36 weeks or more for initiation of breastfeeding at delivery.

33. Comparison of Breastmilk and Formula

34. Primary Driver 2: Capacity of and support for home visitors to address breastfeeding in the target population.
South County Home Health- Well start training

35. Team Pre-work Self Report
How are we doing?

36. South County Home Health
Add Team name
& team
Be creative with your team photo and show your team’s personality!
We all completed Wellstart training successfully and can now use our enhanced knowledge with our families.

37. changes your are testing to achieve this 90 day goal
COLLABORATIVE AIM: Increase exclusive breastfeeding rates at 2 weeks postpartum of women enrolled in HFA who delivered at South County Hospital from 31% to 50% by May 31, 2016.
Team 90 day goal to lead to achieving collaborative aims (how much, by when and for whom): : Increase exclusive breastfeeding rates at 2 weeks postpartum of women enrolled in HFA who delivered at South County Hospital from 31% to 50% by May 31, 2016.
Identify appropriate indicator(s) (in addition to HV-CoIIN measures):
100% of staff will increase their knowledge from less than 70% to more than 80% using the Wellstart Breastfeeding training.
Identify if target HFA breastfeeding mothers are experiencing sore nipples, low milk supply, and/or inability to identify infant feeding cues. Develop tool to track efficacy of interventions.
Changes being tested to meet 90 day goals & collaborative aims:
Staff will utilize knowledge gained through Wellstart training to help breastfeeding moms identify these 3 areas of concern, formulate improvement strategies , reevaluate in hours, refer as needed.
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

38. Ramp of PDSA Cycles:
Implement: Include tool in all HFA home visits from birth to problem resolution.
Cycle 5: Expand to all HFA workers families (2-3 families each) with newborns, evaluate results.
Cycle 3/4: Test tool with 2 HFA workers families with newborns,1-2 families each, evaluate results, revise as needed.
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
Cycle 2: Test tool with one HFA mother-newborn dyad, team evaluation of results, revise as needed.
Cycle 1: Simulate use of Wellstart based training tool with home visitors at a team meeting.

40. Our Annotated Run Chart
No data to report
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.

41. Developing tracking tool to evaluate efficacy of staff interventions.
Our Tools/Tips
Developing tracking tool to evaluate efficacy of staff interventions.

42. Our overall SMART AIM:
SMART AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks (from first service contact).

43. Strong community linkages to breastfeeding support systems
Primary Driver 3:
Strong community linkages to breastfeeding support systems
No PPs submitted for this Driver

44. Team Pre-work Self Report
How are we doing?

45. Family Engagement in Infant Feeding Practices
Primary Driver 4:
Family Engagement in Infant Feeding Practices
East Bay- Infant Feeding Home Visit
Comprehensive CAP- Feeding plan/Visit

46. Team Pre-work Self Report
How are we doing?

47. East Bay Community Action Program
Team Presentation
East Bay Community Action Program

48. SMART AIM: To increase the amount of women exclusively breastfeeding at 3 months and 6 months, by 20% of original baseline of zero by 2/25/16.
By 1/9/15 two Family Visitors will have developed a decision tree/ Infant Feeding Home Visit. By 1/31/15 100% of all Family Visitors will be utilizing the Infant Feeding Home Visit layout at designated time points for prenatal and postpartum mothers.
Identify the appropriate indicator for the cycle. Indicator examples: we will measure the number of moms entering the program prenatally to determine if the infant feeding HV increases the amount of women initiating and sustaining BF.
Ensure the change to be tested is clearly stated. For example: 100% of all HVs will use the Infant Feeding HV layout with all new families.
They answered the 3 questions from the model for improvement

49. ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Cycle 5: Adopt the Infant Feeding HV into practice.
Cycle 4: Gather qualitative and quantiative data. Qualitative data from Family Visitors and Families.
Cycle 3: All Family Visitors will use the Infant Feed HV.
Cycle 2: Two Family Visitors will develop an Infant Feeding HV layout
Cycle 1: Survey 100% of all Moms in the program on their feeding practices.

50. Data: Looking at the data, it is evident that
There is not a steady trend of Mom’s
Initiating BF. The prediction is that
When all HVs use the Infant Feeding
HV more women will initiate BF.
The average amount of weeks that
Moms are BF is 10.5 weeks. The goal
With the Infant Feeding HV is to have
More Mom’s sustaining BF.

51. Materials that are distributed to all Mothers.
Our Tools/Tips
Materials that are distributed to all Mothers.
Other Materials that we use:
BF Benefit Box
Baby Bellies Display

52. Comprehensive Community Action (CCAP)
Team Presentation
Comprehensive Community Action (CCAP)
Be creative with your team photo and show your team’s personality!
During the team process we got staff across agency disciplines excited about breast feeding. We also got breast feeding added to the agency strategic plan

53. changes your are testing to achieve this 90 day goal
Add AIM THAT YOU ARE WORKING ON]
80% of HFA babies due to will have a written feeding plan including supports before the birth of the baby.
We looked at how many moms were due and what the outcomes for them were
We looked at whether having a written feeding plan improved breast feeding duration.
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

54. Ramp of PDSA Cycles: [INSERT THE CHANGE BEING TESTED HERE]
3. Encouraged mom complete a feeding
HV 2-5 days after coming home (giftcard)
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
2. Printed the feeding plan on bright paper and gave it to mom to take to the hospital and sent a copy to the pediatrician
1. Developed a written feeding plan

55. Our Annotated Run Chart
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.
In Nov we had 3 mom’s deliver and 2 feeding plans were completed (66%)
In Jan and Feb we had 2 mom’s deliver and 1 mom due and we completed 3 feeding plans (100%).
In total we had 6 mom’s deliver or due to deliver and we completed 5 feeding plans (83%).

56. Our Tools/Tips
This is a copy of the feeding plan we use.

57. Primary Driver 5:
Data system for tracking all clients breastfeeding intention, initiation, duration and need for and access to breastfeeding support and follow-up
Allegheny County Health Department-Tracking system for capturing families intention, initiation, duration and reasons for discontinuing Breastfeeding
Children’s Friend-Feeding Plan/Birthing plan

58. Team Pre-work Self Report
How are we doing?

59. Allegheny County Health Department NFP
Be creative with your team photo and show your team’s personality!
ACHD NFP learned that our families aren’t far off from where we thought they were and our goals are achievable.

60. changes your are testing to achieve this 90 day goal
Add AIM THAT YOU ARE WORKING ON]
Team 90 day goal to lead to achieving collaborative aims (how much, by when and for whom): By 12/9/15 two of our six nurses will collect data on intent to breastfeed at intake, 36 weeks as well as continue to collect initiation and duration rates. Our goal is to collect data on 100 percent of new enrollees and 75% of participants at 36 weeks of pregnancy.
Identify appropriate indicator(s) (in addition to HV-CoIIN measures):
We collected qualitative data from the nurses to determine whether the tool was positive. 100% of the nurses said that the tool opened dialogue with their clients and was a positive experience.
100% of new clients will be asked intent at intake and 36 weeks pregnant. At this time we have maintained 100%
Changes being tested to meet 90 day goals & collaborative aims:
Creating a questionnaire to answer intent and duration of breastfeeding in all of our clients
Training all of the staff on how to use the tool when working with their clients.
Will the tool impact the amount of time a nurse spends with a client and will it impact how they interact with the client.
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

61. Ramp of PDSA Cycles: [INSERT THE CHANGE BEING TESTED HERE]
Implement: Include the training for the tool in all new staff orientation and implement the tool on all clientele.
Cycles 3: Develop protocol around implementing the tool with all current clientele, not just new clientele.
Cycle 2: Reformat the questionnaire and test on the remaining nurses. Begin to determine a baseline for intent to breastfeed at intake and 36 weeks.
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
Cycle 1: Create the questionnaire and test it on 2 of the 6 nurses in the program.

62. Our Annotated Run Chart
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.

63. Get buy in from the staff at the very beginning.
Our Tools/Tips
Get buy in from the staff at the very beginning.
Make sure everyone is on the same page.
In the beginning we failed to meet regularly which muddied communication.

64. Team Presentation Children’s Friend NFP
Be creative with your team photo and show your team’s personality!
Recognized need for and benefit of standardizing breastfeeding education

65. To increase breastfeeding intention at 36 weeks for prenatal moms
Team 90 day goal to lead to achieving collaborative aims: To increase the number of prenatal women at 36 weeks who have the intention of breastfeeding (note: baseline data unavailable in first 90 days; will specify how much and when for next 90 days.)
Identify appropriate indicator(s) (in addition to HV-CoIIN measures):
Nurses are confident in efficacy and validity of new form
Qualitative feedback from nurses and clients was that the form is a helpful tool.
Qualitative feedback form nurses and clients that completion of feeding plan improves confidence in breastfeeding.
Percent of mothers 36 weeks pregnant who intend to breastfeed.
Changes being tested to meet 90 day goals & collaborative aims:
Enhancement of an evidence-based intake form to collect feeding intent with all clients at enrollment and track breastfeeding education, initiation and duration.
Borrow and test feeding/birth plan.
Pick one of your team’s 90 day goals where you feel you have the most learning to share. Use this slide to summarize your team’s:
90 day goal
measures you are tracking to know if the change is working
changes your are testing to achieve this 90 day goal

66. Ramp of PDSA Cycles: Borrow and Test Feeding Plan
Next Steps: Try with more nurses and clients and add a pre/post assessment for both nurses and clients.
ADD IN YOUR RAMP OF TESTING IF YOU HAVE MULTIPLE CYCLES OF TESTING – EXAMPLE OF ANOTHER PROGRAMS RAMP BELOW
Pick one of the changes from the previous slide. Show how the your team has tested the change over time, differing the conditions (day of the week, who tests it, population, etc.) and scale (amount of time, number of home visits, etc.)
By 1/9/15 two HVs will develop a decision tree & protocol for an “Infant Feeding Home Visit” and test it with 1 family each. By 1/31/15 all home visitors will test the “Infant Feeding Home Visit” with clients approaching 36 weeks gestation.
Cycle 2: Testing combined feeding and delivery plan by two nurses. Both had 2 deliveries and of the 4 clients, 2 are exclusively breastfeeding.
Cycle 1: Testing borrowed feeding plan by two nurses. It was well-received, but clients needed more support at time of delivery.

67. Our Annotated Run Chart
Add in an annotated Run Chart: Add in a data chart from your HV CoIIN Data report, or a run chart for a measure that your team has been tracking for your 90 day goal. Annotate your team’s run chart by adding text boxes to show when your team introduced different changes.

68. Our Tools/Tips: Intake Form & Feeding Plan

69. Faculty and Team reflections on collaborative progress
Final Thoughts
Faculty and Team reflections on collaborative progress
and future direction

70. Team Discussion and Lunch
Team discussion offline (15 minute brainstorm): Given your NEXT 90 day aim, Can you leapfrog toward next aim by stealing something from your colleagues? What ideas do you have for your next test?
LUNCH: 12:30-1:30, you can log off
Log back into adobe promptly at 1:30

71. Lunch 1 hour: 12:30-1:30

72. Report Back/Dialogue on your testing ideas
1:45-2:10
Topic Breakout # 2
Day 1 (after Lunch)
Report Back/Dialogue on your testing ideas

73. Bradford, Sullivan, Tioga
Meeting Street
Kenosha
NE FLorida
South County
Eastbay
Comprehensive Cap
Allegheny
Children’s Friend
What ideas do you have for your next PDSA test?

74. Get Ready to Move to Our Final Plenary for Day 1 at 2:10!