2015 Update Taking care of you is what we do

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1 Community Health Needs Assessment Community Service Plan Update Taking care of you is what we do

2 Community Service Plan Year Update Responding to the needs identified in the Community Health Needs Assessment, throughout 2015 Kaleida Health diligently worked to meet the goals for the projects from the Community Service Plan. With hospitals located in both Erie and Niagara counties, Kaleida Health initiated three projects as part of the Community Service Plan. In Erie County, Kaleida Health is working to increase breastfeeding rates and cardiovascular disease screenings. In Niagara County, Kaleida Health is also working to increase cardiovascular disease screenings and reduce the number of falls for those over age 65. Kaleida Health is proud to report that there was significant progress and completion of 2015 milestones for all three projects. Erie County Breastfeeding Priority Promote Healthy Women, Infants and Children Focus Area Maternal and Infant Health Goal Increase the proportion of New York State babies who are breastfed Objective Increase the percentage of babies breastfed upon discharge at Millard Fillmore Suburban Hospital three percent and at Women & Children s Hospital of Buffalo six percent by December 2016 Kaleida Health s Implementation Plan To increase breastfeeding rates at Women & Children s Hospital of Buffalo and Millard Fillmore Suburban Hospital, Kaleida Health proposed to: Increase collaboration between Millard Fillmore Suburban Hospital and Women & Children s Hospital of Buffalo Women s Services on breastfeeding initiatives. Build out a better continuum of breastfeeding support in both outpatient and inpatient settings from prenatal through labor and delivery and all postpartum care. Link existing internal and community breastfeeding initiatives to maximize efficiency and resources including Great Beginnings NY and Healthy Start Healthy Future for All Coalition. Increase staff education of and expectation to follow breastfeeding friendly practices in support of baby-friendly hospital practices. 1

3 Kaleida Health s Milestones Through the following efforts, Kaleida Health increased breastfeeding rates at Millard Fillmore Suburban Hospital in However, breastfeeding rates at Women & Children s Hospital of Buffalo declined slightly in Women & Children s Hospital of Buffalo Breast Feeding Rates Millard Fillmore Suburban Hospital Breast Feeding Rates Births Breast Fed Total Births Breast Fed Total % % % % % % % % Breastfeeding Champions Lactation consultants at Millard Fillmore Suburban Hospital and Women & Children s Hospital of Buffalo and specific staff members at each of the six OB/GYN Centers continued to serve as breastfeeding champions who evaluate, identify, implement and monitor breastfeeding initiatives. They also continued to track exclusively breastfed and breastfed one hour after vaginal delivery data. Breastfeeding Practices Both hospitals labor and delivery, neonatal intensive care unit (NICU), nursery and postpartum units continued to provide the Breastfeeding Bill of Rights for inpatients, foster skin-to-skin contact within the golden hour, offer rooming in, limit access to formula, and have trained lactation support to foster successful breastfeeding. The six OB/GYN Centers operated by Women & Children s Hospital of Buffalo achieved Breastfeeding Friendly designations in February 2015 and are working to maintain the designation by promoting breastfeeding in Erie County through a comprehensive series of breastfeeding friendly strategies. In August 2015, Women & Children s Hospital of Buffalo was selected to be among the first hospitals in the nation to join the EMPower initiative, a hospital-based improvement initiative funded by the Centers for Disease Control and Prevention s Division of Nutrition, Physical Activity and Obesity, to enhance maternity care practices and work toward achieving the Baby Friendly USA designation. Millard Fillmore Suburban Hospital is also engaged in the EMPower initiative to work toward achieving Baby Friendly designation. As part of this effort, both hospitals receive ongoing support in breastfeeding practices from experienced coaches, as well as training and resource support in lactation education. 2

4 In October 2015, Millard Fillmore Suburban Hospital opened its new NICU, which includes breast milk warmers and individualized breast milk refrigerators in all patient rooms as well as a nutrition and formula room where breast milk can be stored. A breast milk label printer is stationed at the entrance of the unit for new mothers bringing breast milk for their NICU patient. Through membership in the United Way of Buffalo & Erie County s Healthy Start, Healthy Future for All program, the collaboration funded a Baby Café at Women & Children s Hospital of Buffalo. However, the Baby Café closed in 2015 due to poor turnout. Rather than waiting for visitors in the Baby Café, lactation consultants round on the units working with new parents. While doing much better on skin-to-skin at Women & Children s Hospital of Buffalo, rooming in was a challenge in To address these challenges, Women & Children s Hospital of Buffalo developed a workgroup to develop ways to educate parents on the importance of spending more time with their new baby. Training The Women & Children s Hospital of Buffalo Foundation provided a $100,000 endowment to support nursing education as part of the Baby Friendly initiative. More than 260 staff from Millard Fillmore Suburban Hospital and Women & Children s Hospital of Buffalo s maternity, clinics, labor and delivery, mother baby unit, and NICU completed the first four hours of a 20- hour course. Beginning in March 2016, staff will participate in four more four-hour sessions to be completed by the first quarter of Through a certified lactation consultant grant, 28 staff members from both hospitals attended a week-long, 40-hour Lactation Counselor Training course taught by the Center for Breastfeeding in March and October The comprehensive course covered anatomy and physiology; health outcomes associated with feeding choices; benefits of breastfeeding for mother and infant; composition of breast milk; milk storage and handling; proper latch; engorgement; impact of maternity care practices and breastfeeding outcomes; strategies for dealing with breastfeeding problems; and the Baby Friendly hospital initiative. The grant is now complete. Millard Fillmore Suburban Hospital launched a Plan-Do-Study-Act (PDSA) quality improvement project to increase staff training with the goal of ultimately increasing breastfeeding rates. To continue improving rooming in, the hospital is also training staff to provide more care at the bedside rather than having to remove the baby to perform certain procedures. Moving forward, both hospitals are looking into purchase formula since they can no longer get free formula with the Baby Friendly designation. 3

5 Erie County and Niagara County Priority Prevent Chronic Disease Focus Area Increase access to high quality chronic disease preventative care and management in both clinical and community settings Goal Increase screening rate for cardiovascular disease, especially among disparate populations Objective Increase the percentage of women screened for cardiovascular disease at their annual OB/GYN visits from zero to 60 percent Target Disparity Women Kaleida Health s Implementation Plan To address the high rates of cardiovascular disease in Erie and Niagara counties among women, Kaleida Health proposed to: Integrate a Clinical Risk Assessment for Cardiovascular Disease in the annual OB/GYN visits at the women s health centers (OB/GYN Centers). Have practitioners view HeartCaring module and register as HeartCaring staff. Build out the Electronic Medical Record (EMR) to trigger screening questions and automatically calculate risk based on data already present (weight/blood pressure/smoking history/bmi). Provide patients at risk for cardiovascular disease HeartCaring materials and referral to a primary care physician or cardiologist (Have task verification in EMR). Encourage patient to join Spirit of Women to provide support and education (nutrition, clinical speakers, self-check guidance). Solidify referral structure. Kaleida Health s Milestones Kaleida Health s OB/GYN Centers successfully integrated the Clinical Risk Assessment for Cardiovascular Disease in the GYN annual visit. Clinical Implementation In 2015, Kaleida Health s six OB/GYN Centers continued to focus on identifying patients that might be at risk for cardiovascular disease through the HeartCaring screening tool at every annual OB/GYN appointment. Upon arrival, patients are asked to complete the HeartCaring self-assessment. The provider then reviews the patient s self-assessment along with other health indicators within the EMR such as weight, blood pressure, smoking history and body mass index. Patients designated as at risk are given the HeartCaring book, referral to a primary care provider or cardiologist, and all patients are encouraged to sign up as a Spirit of Women member. HeartCaring/Spirit of Women members are sent monthly educational information and invited to educational events including the two 2015 Heart to Heart free community seminars, titled Connecting Diabetes and Heart Disease and Nutrition and Exercise for a Healthy Heart. 4

6 Each OB/GYN Center has a list of primary care offices that are located near the office and affiliated with Kaleida Health. Patients that do not have a primary care physician are given the list and offered assistance in making an appointment. Risk assessment results are recorded in the EMR, and providers can track the number of patients screened, their risk, as well as education and referrals provided. The care team discussed the risk assessment at monthly staff meetings. During these meetings, it was decided that using a red heart sticker as an identifier would help prompt the provider to address a patient that might be at risk. This has helped keep the assessment and cardiovascular disease top of mind in the OB/GYN Centers. When the program officially launched with the patients in October 2014, slightly more than 13 percent of patients were screened. In 2015, participation ranged from 23.5% in February to 45.7% in December. By the end of 2015, 35.3% of patients were screened. Of those screened, 57.4% were determined to be at risk for cardiovascular disease and 13% were determined to be at high risk for cardiovascular disease. The ultimate goal of this initiative is to screen 60 percent of GYN patients by the end of Niagara County Priority Promote a Healthy and Safe Environment: Injuries, Violence and Occupational Health Focus Area Injury Prevention Goal Reduce falls risks among vulnerable populations Objective Reduce the rate of fall related hospitalizations for the 65+ population in Niagara County by 10 percent. Niagara County rate is per 10,000. Kaleida Health s Implementation Plan To address the high number of falls within Niagara County, DeGraff Memorial Hospital proposed to: Increase collaborations with Niagara County hospitals and partner organizations. Offer training, resources and technical assistance to expand the Niagara County Falls Coalition Stay Well On Your Feet/Falls Prevention Outreach Program. Broaden outreach and training of falls prevention education to targeted groups. Kaleida Health s Milestones Kaleida Health served, along with coalition members, as a peer leader and helped seniors and care givers prevent falls by maintaining safe environments. Training In January 2015, DeGraff Memorial Hospital conducted a Train the Trainer staff development program, including a full demonstration of Qi Gong, at Niagara County Community College (NCCC) so instructors had more falls prevention resources to pass on to their students. In 5

7 October, the DeGraff team also presented the Stay Well On Your Feet/Falls Prevention Outreach Program to nursing students at NCCC so they would better understand safety and falls prevention for older adults. Coalition Previously supported by a grant from the Health Foundation for Western & Central New York, DeGraff Memorial Hospital and its McLaughlin Center for Senior Wellness partnered with Niagara County Health Department, Niagara County Office for the Aging, and the Visiting Nursing Association of WNY in the Step Up To Stop Falls initiative. DeGraff and other coalition members again recommitted to the Stay Well On Your Feet/Falls Prevention Outreach Program in Targeting individuals over age 60 by addressing their needs to maintain a high level of independence, the coalition continued to educate older adults on self-management of behaviors geared toward good health and wellness with an emphasis on falls prevention. At the annual planning meeting in December 2015, DeGraff Memorial Hospital met with coalition community partners to review program feedback and plan continued outreach for Community Served In 2015, 93 people participated in one of four Stay Well On Your Feet/Falls Prevention programs offered at various times throughout the year. During each session, participants received a falls prevention workbook and were tasked to make at least one change at home to create a safer environment. Follow up calls to these sessions showed that more than 90 percent of participants said they made at least one positive change to their environment, 100 percent indicated they were satisfied with the program, and 98 percent stated they learned something new about falls prevention. To ensure community awareness, the DeGraff team shared falls prevention educational material at four community outreach events, including an emergency medical services (EMS) provider education event, Niagara County Senior Walk in the Park, Canal Fest and the Falls Prevention Awareness Health Fair. Targeting DeGraff Memorial Hospital s patient population, falls prevention education material and a risk assessment tool were added to all admission packets at the hospital. In addition, DeGraff launched a pilot project to distribute Red Bags containing a night light, falls home assessment tool, and a Stay Well On Your Feet brochure to patients aged 60 and older discharged from the Emergency Department in July and August The goal is to reinstate the program in Throughout the summer, an intern also provided falls prevention education material to patients in the hospital s Emergency Department. 6

8 While the 2015 goal was to launch a new Caregiver Falls Prevention program with families of the DeGraff Adult Day Care, now called the Ralph C. Wilson, Jr. Adult Day Services, staff changes made it difficult to implement the program as planned. The hospital will instead launch the program in In 2015, DeGraff launched a monthly Lunch and Learn program that attracted 25 to 30 participants for each session. In addition, members of the hospital s falls prevention team established new weekly exercise classes for McLaughlin Center members. DeGraff also used the McLaughlin Center newsletter to continue outreach and provide referrals for members. These efforts were successful in reaching another 15 percent of the 500 McLaughlin Center for Senior Wellness members. Dissemination to the Public This 2015 Community Service Plan Year 2 Update is available to the public in the Community Health section of the Kaleida Health, website specifically at A paper version of this report is available upon request. 7

9 Taking care of you is what we do