Welcome OPQC OB & NEO COMBINED ACTION PERIOD CALL. June 27, :00-3:00pm

Transcription

1 Welcome OPQC OB & NEO COMBINED ACTION PERIOD CALL June 27, :00-3:00pm

2 Please don t put us on HOLD To avoid the technical difficulties we encountered from background noise on the May call, today all participants will be muted until the lines are opened for questions, and discussion. Then, if you need to step away Use the MUTE button on your phone or You can use *6 to place the call on MUTE and *6 to come off of MUTE

3 Agenda 2:00pm Welcome and Roll Call and why are we here? Sandy Fuller 2:05 pm Current state and efforts to close the Gap Neo Infection Project Neo HM project HM Subgroup 2:15pm Closing the Gap OB and Neo Partnership to Promote Human Milk for High Risk Infants Dr. Laurel Bookman Dr. Laurel Bookman Dr. Jay Iams 2:20pm Closing the Gap Drivers and Changes to move the dots Dr. Laurel Bookman Dr. Jay Iams Team sharing Educational Strategies 2:55 pm Next Steps Sandy Fuller

4 Why Are We Here? The story of Gabby and her family s lost dreams Watch the story as told by her Dad, working with the PQCNC CLABSI Project

5 What will success look like? Processes OBs and nurses will talk to high risk moms at every contact to help them plan to initiate early pumping Moms of high risk infants will start expressing milk early and often - to assure an adequate supply for their infant in the NICU and after D/C Outcomes Lower Rates of Infection in high risk NICU infants Costs savings (less $ for donor milk)

6 How do we do it? Milk is Medicine - Liquid Gold My spirits lifted when I learned there was something I could do to help, Christie Lillie She remembers nurses referring to mother s milk as liquid gold and that made her realize how special every single drop of her milk was Christie and DJ Nemo Lillie

7 Neonatal Infection Project Project Goal Eliminate late onset (>72hrs) bacterial blood stream and CSF infections in infants in Ohio NICUs SMART AIM SMART AIM By June 2013 we will reduce late onset (>72 hrs.) blood stream/csf infections in infants weeks gestational age to < 10% in Ohio NICUs

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9 N O C H A N G E A D D E D Project Goal SMART AIM Human Milk Project Eliminate late onset (>72hrs) bacterial blood stream and CSF infections in infants in Ohio NICUs SMART AIM By June 2013 we will reduce late onset (>72 hrs.) blood stream/csf infections in infants weeks gestational age to < 10% in Ohio NICUs HUMAN MILK AIM For all infants weeks GA: 1)HM begun within 72 hrs. in >80%. 2) 100 ml/kg/day of HM by 21 days of life >95%) - MOM maximized - DM minimized - Formula eliminated

10 Original Human Milk Subgroup Human Milk Subgroup formed to identify strategies to improve HM results (in an effort to achieve overall infection AIM) Partnership OB & Neonatal team members Focus on prenatal education of all moms about the benefits of breastfeeding Develop and test tools Thank you to the individuals from the following hospitals who are part of the Human Milk Subgroup: Akron General, Akron Children s, Cincinnati Children s, Dayton Children s, Mercy St. Vincent Medical Center, ProMedica Toledo, Rainbow Babies and Children s

11 Drivers and Changes to Close the Gap OB & NEO PARTNERSHIP TO MOVE THE DOTS

12 OB and Neo Partnership to Promote Human Milk for High Risk Infants Eliminate late onset (>72hrs) bacterial blood stream and CSF infections in infants in Ohio NICUs Aim SMART AIM By June 2013 we will reduce late onset (>72 hrs.) blood stream/csf infections in infants weeks gestational age to < 10% in Ohio NICUs For all infants weeks GA: 1)HM begun within 72 hrs. in >80%. 2) 100 ml/kg/day of HM by 21 days of life >95%) - MOM maximized - DM minimized - Formula eliminated Key Drivers Expert knowledge staff across all disciplines and units Ensure supportive care transitions across multiple disciplines and units All pregnant women receive education about the benefits (for both mother and infant) of breastfeeding/hm for high risk infants Evidenced based care practices that supports breastfeeding and provision of MBM for high risk infants at time of mother s Admission Evidenced based care practices that supports breastfeeding and provision of MBM for mothers of all high risk infants while in L&D Evidenced based care practices that supports breastfeeding and provision of MBM for all infants while mom in hospital Administrative/Leadership to promote and support breastfeeding and use of HM Practice Changes All staff ( OB, Prenatal, Antepartum, L&D, Mother-Baby, NICU, Transport Team, Pediatrics post discharge) educated in the benefits of breastfeeding for both mother and infant and specifically human milk for preterm high risk population. Job descriptions and competencies reflect knowledge and skills related to care of breastfeeding dyad All staff provide consistent messages and support to initiate and promote continued expression/pumping of human milk for NICU patients throughout care continuum All women should be informed of the benefits of breastfeeding for both mother an infant and specifically the benefit of human milk for preterm high risk infants Consider using OPQC Handout Partnering in your NICU Infant s Care Antenatal consult (NICU team) on admission for high risk mothers (admitted for preterm labor or other complications) All Mothers should be shown (by trained L&D nurse) how to hand express colostrum after delivery Expressed colostrum collected and given to NICU or transport team Encourage frequent hands on pumping (using both hands and pump) throughout hospital course to promote lactogenesis and adequate supply. (see Jane Morton video ttp://newborns.stanford.edu/breastfeeding/maxproduction.html for rationale and instructions. Consider showing mom video on her phone or smart device Encourage mother to keep pumping log Encourage/enable mom to visit NICU and participate in Kangaroo Care as soon as medically safe to do so, and as often as able Referral for LC support in hospital Referral to outpatient LC support and community resources after D/C Develop plans for provision of hospital grade breast pumps for mothers of all NICU infants prior to d/c home Physician and administrative leadership commitment to project goals and support team by removing barriers to achieving them

13 Where YOU can make a difference

14 Driver: Prenatal Care Education for all high risk pregnant women about the benefits (for both mother and infant) of breastfeeding and /HM for high risk infants Doctors Inform all women of the benefits of breastfeeding for both mother an infant Optimally educational message delivered by 20 weeks and repeated at every prenatal visit Inform high risk women about the benefit of human milk for preterm high risk infants Nurses Consider using JC Speak UP Reinforce message - consider using OPQC Handout Partnering in your NICU Infant s Care

15 Driver: High risk admission Evidenced based care practices that supports breastfeeding and provision of MBM for high risk infants Doctors Remind high risk women about the benefit of human milk for preterm high risk infants Order Antenatal consult (by NICU team) on admission for high risk mothers (admitted for preterm labor or other complications) or within 24 hours if not done on admission Nurses Facilitate consult and reinforce messages Share OPQC Handout Partnering in your NICU Infant s Care When you order antenatal steroids be sure you also order a referral for Lactation Consultant

16 Driver: During Labor and PP Evidenced based care practices that supports breastfeeding and provision of MBM for mothers of all high risk infants Doctors Order consult (by NICU team) for high risk if not done on admission Order pumping within the first 3 hours of delivery and 8 times in 24 hours through hospital stay Nurses Trained L&D nurse shows mother how to hand express colostrum after delivery Expressed colostrum collected and given to NICU or transport team DAYTON CHILDRENS

17 Driver: : While mom is an inpatient after delivery Evidenced based care practices that supports breastfeeding and provision of MBM for all infants Doctors Encourage mom to visit NICU and participate in Kangaroo Care as soon as medically safe to do so, and as often as able Nurses Encourage frequent hands on pumping (using both hands and pump) throughout hospital course to promote lactogenesis and adequate supply (see Jane Morton videos on hand expression and hands on pumping for rationale & instructions CLEVELAND CLINIC Patient education - consider showing mom video on her phone or smart device Encourage mother to keep pumping log

18 Driver: After Delivery Evidenced based care practices that supports breastfeeding and provision of MBM for all infants Doctors Referral for Lactation Consultant (LC) support after delivery Nurse Administration Develop plans for provision of hospital grade breast pumps for mothers of all NICU infants prior to d/c home Referral for outpatient LC support and community resources after D/C home Nurses Develop plans for provision of hospital grade breast pumps for mothers of all NICU infants prior to d/c home

19 Driver: Administrative/Leadership to promote and support breastfeeding and use of Human Milk Physician and administrative leadership commitment to project goals and support team by removing barriers to achieving them

20 Improving Breastfeeding Rates for Mothers/Infants at Nationwide Children s NICU at Riverside Marsha Dumm MS,RD,LD 20

21 100% of infants whose mother s have expressed the desire to breast feed will be put to breast at least once daily on the days mother visits beginning June 2013 and be sustained indefinitely. Larger Aim NICQ 8 All infants will achieve full oral feeds by 37 weeks Vermont Oxford Network NICQ 8 21

22 Concurrent events created the ideal atmosphere to advance our aim. OPQC Extensive data collectionhour of first feed of EBM, amount of EBM/Donor milk received in first 72 hours, day 21. Riverside s Baby Friendly Initiative BF education for all RMH L&D,MIU RNs, OBs, Peds Lactation Riverside L&D, MI NICU Cue based feeding comm. Educated staff on scoring infant at breast Additional LC support 32 hours per schedule from LC/NICU RN Vermont Oxford Network NICQ 8 22

23 February Rule to Promote Early Pumping (See next slide) April 2013 Non-nutritive Suck at Breast Guideline Approved June 2013 Standing OB postpartum order set Breast Care: Lanolin cream PRN sore nipples Mother to begin breast pump within 3-6 hours of delivery if baby admitted to NICU/NSCU Mother/Family Education-Broadcast UCSD Supporting Preterm Infant Nutrition Step 1: Skin to skin Step 2: First time at breast Vermont Step 3: Learning to breastfeed Oxford Step 4: Getting better at breastfeeding Network Step 5: Getting ready to go home NICQ 8 23

24 Table tents distributed to all MI units and NICU Vermont Oxford Network NICQ 8 24

25 Should our resources be directed at educating nurses or families? Educating staff would be a more stable/consistent way of standardizing processes. Staff turnover <7% annually. Would adding one more task to RN responsibilities be reasonable. Current orientation and annual updates include BF education, but there is not strong support for cementing the mother/infant BF dyad. For infants that go to breast more frequently, it appears that the mother is the driving force in the process. Broadcast of UCSD info is planned, but do we have adequate resources to provide information to 90% of 600 admissions. We can teach, but how can we fully motivate and support. Vermont Oxford Network NICQ 8 25

26 Team members have worked individually and as a group on various improvement projects and standardization efforts: Skin-to-skin care, cue based feeds, discharge planning, feeding advancement/standardized use of nipples We are convinced that Interdisciplinary membership increases the collective intelligence and deepens our understanding of the problem. We are lucky to have 2 neonatologists participating in this project and believe that MD involvement is imperative to move a project forward. Nationwide Children s has a well defined strategy for quality efforts with a medical director for the division and a dedicated specialist from the QI department and quarterly meetings for the entire team. Vermont Oxford Network NICQ 8 26

27 Education Strategies Hand Expression - Link to video: Or search Jane Morton hand expression Hands on Pumping Link to video Or search Jane Morton hands on pumping SPIN Program pin/video/pages/default.aspx Link to research article: Note: Dr Morton has allowed individual OPQC teams to use her videos on their patient education channel. For permission contact Mr. Barry bar477@charter.net

28 Handout For NICU Moms Milk is medicine message Available on OPQC Website opqc.net/resources/publications

29 For all infants weeks GA: HM begun within 72 hrs. in >80%. 2) 100 ml/kg/day of HM by 21 days of life >95%) - MOM maximized - DM minimized - Formula eliminated Next Steps: OBs Will your OB and Neo teams partner to achieve the Human Milk Project AIM? YES NO Stop here Do you have prenatal patients scheduled week? YES NO, I am scheduled on deliveries this week Commit to remind high risk women about the benefit of human milk for preterm high risk infants Commit to ordering pumping within 3 hours and 8 times every 24 hours

30 Next Steps: Nurses For all infants weeks GA: HM begun within 72 hrs. in >80%. 2) 100 ml/kg/day of HM by 21 days of life >95%) - MOM maximized - DM minimized - Formula eliminated Will your OB and Neo teams partner to achieve the Human Milk Project AIM? YES NO Stop here Do you or your staff need education as a first step? YES Share video links with 1 or 2 staff members and ask for feedback, then Share more widely and NO Commit to one or more of the following: Test showing the video to one mom by next week Help a mom express colostrum for next baby needing transport Enable/encourage one mom to visit NICU early after del. Or any other suggested change

31 Next Steps Plan to share your small tests of change on upcoming OB and Neo Action Period calls and the November Learning Session A P S D A P S D

32 Upcoming Action Period Phone Calls Obstetrics Call July 25 th from 2:00-3:00pm Neonatal Call August 7 th from 2:00-3:00pm Call In Information Call-in Number: Passcode: