1. Connecticut Perinatal Quality Collaborative Meeting November 10, 2015 Matthew Bizzarro, MD Yale-New Haven Children’s Hospital

2. Yale-New Haven Children’s Hospital Neonatal Intensive Care Unit 54 bed, level IV NICU 800-850 admissions per year 125-150 very low birth weight (VLBW; <1500 grams) admissions per year

3. Yale-New Haven Children’s Hospital Neonatal Intensive Care Unit Team Members: Project manager/QI consultant: Matt Bizzarro, MD Co-manager: Amy Embleton, MS, MA, IBCLC, OTR/L\ Other participants: Orly Levit, MD; Steve Peterec, MD; Yeisid Gozzo, MD; Jacob McPadden, MD; Renee Mobley, MD; Alaina Pyle, MD; Melissa Posner, MD; Luisa Gonzalez-Balesteros, MD; Emily Gritz, MD; Amaris Keiser, MD; Loren Nallu, MD

5. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Primary Aim: To increase the use of exclusive breast milk feeding (with and without fortification) at NICU discharge by 20% Background: Exclusive breast milk feeding is the preferred method of feeding for preterm and term infants in the NICU given its potential short and long-term benefits, including enhanced immunologic function and prevention of necrotizing enterocolitis

6. Percent of Infants Discharged Home from the Yale NICU on Breast Milk (with and without fortification)

7. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Primary Driver: Inadequate parental education prior to NICU admission Secondary Driver: Lack of consistent and effective education during prenatal consultation

8. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Goal: To improve parental education regarding the benefits of maternal breast milk to the NICU population: Train NICU medical staff performing inpatient and outpatient prenatal consultations to better educate families through consistent messaging Develop and distribute educational materials for families as part of the prenatal consultation process Document parental education and distribution of materials regarding the benefits of human milk to the NICU population and to mom

9. Baseline Data MeasureData SourceTarget% of Time Target Achieved % of prenatal consultations with documentation of discussion regarding the benefits of breast milk use in the NICU population Electronic Medical Record (EPIC) 100%56% % of prenatal consultations with documentation of distribution of educational materials regarding the benefits of breast milk use in the NICU population Electronic Medical Record (EPIC) 100%0

10. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Plan : Educational sessions devised for attending staff and fellows who perform inpatient and outpatient prenatal consultations Hand-out created: Includes benefits of breast milk/breast feeding to both mom and baby (NICU specific) Includes web links for more information Consultation note template revised in EPIC to include whether or not hand- out discussed and provided (hard stop)

13. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Do : Educational sessions completed for all staff on September 25, 2015 Hand-out finalized, translated and posted on October 6, 2015 Consultation note template appears in EPIC for use on October 12, 2015 Medical staff begin implementation of new information on October 15, 2015

14. Study: Post-Implementation Data MeasureData SourceTarget% of Time Target Achieved Pre- Intervention % of Time Target Achieved Post- Intervention % of prenatal consultations with documentation of discussion regarding the benefits of breast milk use in the NICU population Electronic Medical Record (EPIC) 100%56%86% % of prenatal consultations with documentation of distribution of educational materials regarding the benefits of breast milk us in the NICU population Electronic Medical Record (EPIC) 100%086%

15. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Barriers: Prenatal consultations do not capture our entire patient population Delays in changing templates and getting documents approved Marketing Health system-wide approval

16. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Unexpected opportunities: Overhaul of the prenatal consultation process Improved system for notification Increased expectations Improved documentation Modification of the discussion regarding donor breast milk

17. Yale-New Haven Children’s Hospital NICU: Hi-Mom Initiative Looking forward: Continue to collect data and receive feedback from medical staff Discuss utility of hand-out and collect data from post- partum moms: Did they receive it? Were the major points reviewed? Did they read it? Was it easy to follow? Did they access any of the web-based information? Did it influence their decision?

18. Thank You