1. Lactation Management & Multidisciplinary Breastfeeding Quality Improvement DATE A BBC document developed by Region 8 RPPC with Title V funding through CDPH/MCAH, 2010.

2. Goal : Clarify role of lactation management and multidisciplinary QI in pursuit of Baby Friendly designation Well baby Baby Friendly NICU Use of donor milk CLE staff ed Out pt f/u MD education Work place lactation Staff competencies Data collection Staff continuing ed

3. Objectives: The learner will be able to Examine statistical parameters of current Hospital’s perinatal practice and their implications for lactation management (i.e. Are we going up or down & why?)

4. Objective: Discuss the findings of Hospital’s staff needs assessment (i.e.What do we know? What do we need to know?)

5. Objective: Relate the Plan, Do, Check, Act cycle to Hospital’s quest for Baby Friendly designation (i.e. What have we done? What do we still need to do? )

6. Objective: Identify the role of multidisciplinary QI (MQI) in the further pursuit of Baby Friendly designation (i.e. How can we ALL work together to make it happen? )

7. Statistical Snap Shot of Your Hospital Perinatal Profile Data

8. Symbol Key ▲▼= high or low rates relative to state ↑↓ = dynamic changes relative to your past performance or population ~ = stable rates relative to your past performance

9. Hospital Demographics Live Births = 2,520 ⃗ 2,401 ⃗ 2,103↓ White = 51.0% ⃗ 44.1% (▲) ↓ Hispanic = 32.3% ⃗ 37.1% ↑ Black = 5% ⃗ 3.2% ↓ Asian/Pac Islander = 14.9 % ⃗ 16.9 % ↑ Other = 0.2% ~ Foreign Born = 26.4% ⃗ 25.8% (▼) ↓

10. Perinatal Characteristics Low Birth Weight = 5.7 % ⃗ 6.1 % ↑6.5 % VLBW, MediCal (▼), Moms <18 (▼) =↓ Multiples (▲) = 3.9% ⃗ 4.6% ↑15% Mothers (▲) >34 = 22% ⃗ 22.1% ~ Incomplete high schl (▼) =10.1 % ⃗4.3 % ↓

11. Prenatal Care First trimester (▲) = 95.5% ⃗ 96.6% ↑ Third trimester (▼) = 0.5% ⃗ 0.4% ↓sl No prenatal care = 0.3% ⃗ 0.2% ↓sl Unknown care = 0.1% ~ Hospital + prenatal patients = Rank in the county?

12. Cesarean Sections (’02- Present) Primary = 17.4% ⃗ 19.3% ↑ ’02-’08 Repeat = 10.3% ⃗ 13.5% ↑ ’02-‘08 Current rates: 33% Primary = 18-20%

13. Hospital Death Cohort Data

14. Birth/Death Cohort Ratios Fetal Mortality (≥ 500 grams) Indicator: Prenatal & Perinatal Care Standardized Ratio = 0.82 Neonatal Mortality (Birth to 28 days) Indicator: In-hospital care Standardized Ratio = 0.78 Post Neonatal Mortality (29 days - 1 yr) Indicator: Access to/quality of community care Standardized Ratio = 0.61

15. Birth Certificate Missingness Why do we care? Hospital 2005-2006 = < 2% What’s missing?

16. Birth Certificate Missingness -2005 Gestational Age Maternal Ed in years

17. Birth Certificate Missingness -2006 Gestational Age Maternal Ed in years

18. Hospital Patient –Staff Partnership

19. Zeroing in on Breastfeeding

20. Hospital Lactation Management Ex BF Rates ↑ <1% annually prior to Soft/BBC Rates ↑ 2.5% (average) annually after

21. Breastfeeding Data Implications Current EX BF rate = 58% Questions from the data Is 58% accurate – are all pts counted by whom, using ? Tool Ask the staff!!

22. Hospital Needs Assessment

23. Hospital Needs Assessment Summary

24. Implications of Needs Assess. Findings 20 respondants – all depts represented? All comfortable w/Soft-BBC information All comfortable w/using the information Risk/referral questions (#7,8) a little scatter ?Recognizing risks ?Referral resources ?Staff role delineation Multidisciplinary QI Team-how is MQI change communicated? 25% aware of a MQI Team (#10) 50% either no input or input not used (#11, 12, 13) 25% see no change after MQI (14)

25. Implications of Needs Assessment Findings

26. Possible MQI Activities (from needs assessment) Data accuracy Some staff need help with Recognizing risks Referral resources (in-pt, out-pt?) Staff role delineation (RN vs CLE vs CLC vs IBCLC)

28. QI Issues Clarification of data collection – accuracy Tools Sources of data Collection period of time

29. Evaluation of Outcome Data Crosscheck data sources – do they agree

30. Tools of the Trade

32. Implementation of Policy Review/Revision for Data Collection Share hard data w/MQI Committee Explore role of MQI Committee Follow process for policy/procedure changes Clarify responsibilities Communicate

33. Other MQI Activities (from needs assessment) Some staff need help with Recognizing risks Referral resources (in-pt, out-pt?) Staff role delineation (RN vs CLE vs CLC vs IBCLC)

35. MQI Breaks down the silos of health care in and out of the hospital NICU Mother Baby In Patient L&D Out Pt MDs Lactation Administration Nursery Risk Management

36. Wrap Up The evidence says.... to your perinatal staff and service To achieve and maintain Baby Friendly, everyone has to jump on board

37. MQI smooths the bumps in the road, creating partnerships

38. Our most important partners... Thanks for the good work you do!!