1. BREASTFEEDING PERFORMANCE IMPROVEMENT Using data to drive practice Karen Callahan, MSN RN Director Maternal Child Services Palos Community Hospital

2. 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 Hospital

3. 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.

4. 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.

5. GE Centricity Perinatal Labor & 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 1 st hr post delivery

6. Meditech Assessments

7. Meditech EMR

8. Meditech Assessments

10. Breastfeeding Rates at PCH Years 2000-2010

11. MONTHLY STATISTICS Dec- 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 TOTA LS NEWBORN ADMISSIONS*7287979079111112109120899883 1147 IDENTIFIED BREASTFED NEWBORNS487473755885848295757363 885 EXCLUSIVELY BREASTFED16222330223238 35323931 358 % OF EXCLUSIVELY BREASTFED33%30%32%40%38% 45%46%37%43%53%49% 40% DOCUMENTED REASONS FOR NOT EXCLUSIVELY BREAST FEEDING <37 Completed weeks of gestation200001023000 8 Discharge from the hospital while in SCN111 213101002 13 Dehydration/10% Weight loss410 265566679 57 Patient Request142329 2020 1637252840292112 294 Other Documented Reason for Not Exclusively Feeding Breast Milk51713 16161271457639 114 REASONS FOR OPPORTUNITY FOR IMPROVEMENT Mother Requested Supplementation & No Physician Order 245300022100 19 No Physician Order for Supplementation 462210111130 22 0 0 0

14. 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.

15. 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

16. 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

17. 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

18. EBBHI Project Timeline 2012 EBBHI Project Timeline 2012 Complete Network Breastfeeding Practice Survey 1 st Quarter Hospitals Identify Champions Create a breastfeeding committee Complete Baby Friendly Assessment Report Baseline Quality Outcomes Report Status 2 nd Quarter Create a workplan Breastfeeding policy development/revision Report Status

19. EBBHI Project Timeline 2012 EBBHI Project Timeline 2012 3 rd Quarter Implement workplan Educate staff and providers Report Status 4 th Quarter Report Monthly Quality Outcomes Complete Network Breastfeeding Practice Survey Report Status

20. 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

21. Questions?