Park Nicollet Midwife Dept Telephonic Breastfeeding and Postpartum Support Pilot Project

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Morgan Reed
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1 1/26/17 Project Leaders: Jennifer Bourgoine, RN, BSN Ivy Emery, RN, BSN, PHN Kate Johnson, RN, MN, PHN, DNP Student Park Nicollet Midwife Dept Telephonic Breastfeeding and Postpartum Support Pilot Project Disclosures- We work for Park Nicollet Clinics and Methodist Hospital through which the project was completed. Objec-ves: Describe the Telephonic Breas=eeding and Postpartum Support Pilot Project. Understand how the telephonic breas=eeding and postpartum support contributes to the triple aim of health, experience, and affordability, and decreases barriers to care. Iden-fy the top reasons pa-ents indicated as reasons for formula supplementa-on. Discuss breas=eeding rates pre-interven-on and post-interven-on, including rates by pa-ent race. Discuss how telephonic breas=eeding and postpartum support can increase pa-ent sa-sfac-on with postpartum care. Discuss recommenda-ons that can be implemented in health care systems to provide telephonic breas=eeding and postpartum support. Partnerships for planning and implemen-ng project Methodist Midwives Pa-ents Methodist Midwives Team and Nurses Methodist Hospital Family Birth Center Park Nicollet Maternal Child Health Home Care Park Nicollet Breas=eeding Center Lacta-on Consultants Park Nicollet Women s Services Park Nicollet Quality Improvement Team 1

2 1/26/17 Introduc-on Ø The early postpartum period (first 6-8 weeks a[er delivery) is a cri-cal period for establishing long-term breas=eeding prac-ces. Ø We have heard from pa-ents that they try to deal with their breas=eeding struggles on their own and some-mes wait to long to seek help from Lacta-on Consultants or give up breas=eeding. Ø Many pa-ents feel can overwhelmed and stressed with adjus-ng to bringing a baby home and can experience the baby blues. Ø 1-2% of pa-ents will develop postpartum depression and anxiety. Ø Pa-ents have provided us with feedback that they felt a lot of support during their pregnancy (especially at the end with frequent appointments), but then once they le[ the hospital, the support was gone. Ø A support phone call to pa-ents a[er they deliver is a powerful, posi-ve tool to show pa-ents we care about their health and experience. Telephonic Breas=eeding and Postpartum Support Interven-on Ø PN Midwife Dept Triage Nurses completed outbound support phone calls to all pa-ents who delivered with the Midwife Dept. Ø The support phone calls incorporate the pa-ent s care from hospital discharge and the home care visit, which provides con-nuity of care to address already iden-fied concerns and personalize the support we can provide. Ø The support phone calls address overall postpartum and breas=eeding care: Ø support at home for the pa-ent Ø self care and sleep for the pa-ent Ø breas=eeding (feeding schedule, baby s behavior, nipple concerns) Ø postpartum care and healing Ø mental health concerns (anxiety, depression) Support Phone Calls Ø Ini-ate support phone call to pa-ents at approx. day 5 postpartum a[er collabora-ng with PN Maternal Child Home Care Nurse. Provide educa-on and support to pa-ents and place referral to PN Lacta-on Consultants if a concern was iden-fied. If unable to reach pa-ent on ini-al acempt, pa-ents received a voic offering support. Every pa.ent receives a postpartum support le7er which includes contact numbers for Midwife dept and PN Lacta-on Consultants. Ø Follow-up phone calls to pa-ents at approx. day 1 postpartum for pa-ents reques-ng an addi-onal support phone call or 2 nd acempt at reaching pa-ents.- Ø During project, 2 nd phone call was stopped in mid-may 217 due to high level of day 5 call volumes needing to be completed. Ø Pa-ents with iden-fied concerns receive addi-onal phone calls for collabora-ng plan of care and offering support. Prenatal Breas=eeding Educa-on Even though we have mul-ple breas=eeding educa-on materials in our prenatal core curriculum, we realized there wasn t a standard, consistent conversa-on occurring with the Midwives and pa-ents regarding feeding plans and past breas=eeding experiences. Interven.on: Created a Newborn Feeding Plan form that was given to pa-ents at the 28 week prenatal visit to start the conversa-on between the Midwife and pa-ent and target breas=eeding educa-on. Topics in Feeding Plan: Inten-on to breas=eeding, formula feed, or combo feed (breastmilk and formula) Support from partner and family for feeding with breastmilk Support at work to use breast pump Acending breas=eeding classes U-lizing WIC Breas=eeding Peer Counselors if enrolled in WIC Previous experiences with breas=eeding other child(ren), including dura-on and difficul-es/challenges. 2

3 1/26/17 Aim Statement for Project Ø Show that the telephonic breas=eeding support model used to call pa-ents a[er hospital discharge, along with collabora-on with Home Care and Lacta-on Consultants, is effec-ve at helping pa-ents achieve their breas>eeding goals in the first 6 weeks postpartum. Ø Subsequently show the telephonic breas=eeding support model will increase breas=eeding exclusivity and dura-on rates at 6 weeks postpartum and increase u-liza-on of Lacta-on Consultants (consult appointments). Ø Standardize the -ming of breas=eeding educa-on and have more in depth, pa-ent-specific conversa-ons with pa-ents during prenatal care/visits. Triple Aim Summary for Telephonic Breas>eeding Support Health Early ini-a-on of effec-ve breas=eeding and maintaining adequate milk supply are cri-cal to establishing long-term breas=eeding prac-ces. Early iden-fica-on of breas=eeding concerns can help address problems before they become complex medical issues or deter mothers from exclusive breas=eeding. Opportunity to iden-fy and address addi-onal postpartum and/or mental health concerns. Experience Provides equitable care to all pa-ents. Closes the gap and removes barriers for support and educa-on between delivery and postpartum visit. Increases pa-ent sa-sfac-on and support during early postpartum -me. Supports mother in her breas=eeding goals and confidence level. Affordability Early iden-fica-on of breas=eeding concerns decreases costs from complex breas=eeding problems/visits. U-lizing RN/Lacta-on Consultant support is more -mely and cost effec-ve than clinic visits. Increased breas=eeding exclusivity and dura-on are known to decrease the longterm health care costs. Project Timeline October 216 Started baseline data gathering with CNM Dept Newborn Feeding Survey at postpartum visit for all Midwife pa-ents. Midwives started using Newborn Feeding Plan at 28 week prenatal visit to help standardize and facilitate the breas=eeding conversa-on with pa-ent. February 217 Half day training for CNM Dept Triage Nurses involving breas=eeding triaging and pa-ent educa-on and pilot project processes/workflows. February 2 th 217 Go-live for Midwife Dept Triage Nurses to call pa-ents a[er discharge from Methodist Hospital. April- July 217 Collected post-interven-on data with CNM Dept Newborn Feeding Survey at postpartum visit for all Midwife pa-ents. Prepara-on for the Support Interven-on included: Collaborated with PN Maternal Child Health Home Care and PN Lacta.on Consultants to develop workflows. Created Epic documenta-on tools, project tracking tools, pa-ent surveys. Provided addi-onal training for Triage Nurses for breas=eeding and postpartum mental health assessment/triaging and pa-ent support and educa-on. Created Newborn Feeding Plan for Midwives to discuss/teach breas=eeding at 28 week prenatal visit. Created SmartText for documenta-on in Problem List. Beginning of July 217 Ended support phone calls as part of pilot project. We will con-nue to support pa-ents needing follow-up/addi-onal support as iden-fied by Midwives and PN Home Care. 3

4 1/26/17 Supplementa-on with Formula (Baseline survey data) q The median age of supplementa-on with formula is 7 days postpartum (newborn 7 days old). q The top 4 reasons pa-ents supplemented with formula were: q Low milk supply q Returning to work q Nipple pain q Fussy baby q Low milk supply, nipple pain, and fussy baby can be iden-fied during a telephone conversa-on with pa-ents and provide the opportunity to give pa-ents referrals to the Lacta-on Consultants for early interven-on before the concerns become worse or lead the pa-ent to stop breas=eeding. q Breas=eeding educa-on given prenatally to pa-ents can focus on these top reasons for supplemen-ng so pa-ents are aware of what to expect and are encouraged to seek help and advice for concerns. Support Phone Calls Data Percentage of pa-ents reached Month Feb 2 th - March 217 Total # of CNM births Total # of phone calls out to pa.ents Total # of phone conversa.ons with pa.ents % April % May 217- June % % of pa.ents reached Total # of pa-ents reached by race Pa.ent Race White Black Somali Asian Hispanic Total # of Pa.ent Conversa.ons % of Pa.ent Conversa.ons Total % of Births by Pa.ent Race in Midwife Dept % 21% 13% 6% 5% 56.2% 31.8 % Reported in BirthTracks with Black category 6.4% 4.2% Total Data: Feb 2- June

5 1/26/17 Data from conversa-ons with pa-ents Month Feb 2 th - March 217 # of pa.ents # of pa.ents breas>eeding who had at discharge supplemented by the.me of support phone call % of pa.ents Total # of who had pa.ents with supplemented BF or PP by.me of support phone call concern iden.fied during phone call % 25 42% April % 16 37% May 217- June 7 th % 2 31% % of pa.ents with BF or PP Concern iden.fied during phone call Support Phone Calls Ø Average -me of conversa-ons and follow-up with pa-ents is about 2 minutes (include -me to place referrals and documenta-on). Ø Amount of -me the en-re coordina-on of the project takes each day varies from 1-4 hours based on pa-ent volume (includes discharge and home care messages, calling pa-ents, coordina-ng care, mailing lecers). Ø There have been some days in which nurses could not focus on the project due to being short triage nurses and needing to focus primarily on triaging. Newborn Feeding Surveys Newborn Feeding Survey Data Baseline Surveys- 223 completed Feeding Surveys from postpartum visits from October 216-January 217 for pa-ents who received prenatal care from the Park Nicollet Methodist Midwife group. Post-Interven.on Surveyso 13 completed Feeding Surveys from postpartum visits from March- June 217 for pa-ents who received prenatal care from the Park Nicollet Methodist Midwife group. The following categories of pa-ents were excluded from our data: Preterm (delivery before 37 weeks GA) Newborn admiced to Special Care Nursery Of note- demographic data on the Feeding Surveys was not complete on all submiced surveys, so pa-ent totals regarding race is smaller than overall complete survey totals. 5

1/26/17 Baseline Data- Prenatal feeding inten-ons compared to current feeding prac-ces at postpartum visit 1 9 8 7 6 5 4 3 2 1 79.5 Baseline Data- Feeding inten-ons vs.

8 66 22 Breastmilk/Formula Feeding Inten-on Formula Only Feeding Inten-on Exclusive Breastmilk Breastmilk/Formula Formula Only Feeding Prac-ce Post-Interven-on Data- Prenatal feeding inten-ons

6 1/26/17 Baseline Data- Prenatal feeding inten-ons compared to current feeding prac-ces at postpartum visit Baseline Data- Feeding inten-ons vs. current feeding prac-ces by percentage (n size= 233) Exclusive Breastmilk Feeding Inten-on Breastmilk/Formula Feeding Inten-on Formula Only Feeding Inten-on Exclusive Breastmilk Breastmilk/Formula Formula Only Feeding Prac-ce Post-Interven-on Data- Prenatal feeding inten-ons compared to current feeding prac-ces at postpartum visit Post-Interven.on Data- Feeding inten-ons vs current feeding prac-ces by percentage (n size = 13) Exclusive Breastmilk Feeding Inten-on Breastmilk/Formula Feeding Inten-on Formula Only Feeding Inten-on Exclusive Breastmilk Breastmilk/Formula Formula Only Exclusive breas=eeding rates by pa-ent race Total # of completed surveys Percentage of pa-ents with exclusive breas=eeding inten-ons versus exclusive breas=eeding prac-ces by race 14 Total number of completed surveys by pa-ent race-pa.ent count Total # of Completed Baseline Surveys Total # of Completed Post- Interven-on Surveys White Black Somali Hispanic Asian White Black Somali Hispanic Asian Baseline Exclusive Breas=eeding Inten-on Post-Interven-on Exclusive Breas=eeding Inten-on Baseline Exclusive Breas=eeding Prac-ce Post-Interven-on Exclusive Breas=eeding Prac-ce 6

1/26/17 Post-Interven-on Survey Pa-ent sa-sfac-on with Support Phone Call Pa.ent Quotes I loved the call! The nurse was so helpful and answered all my ques-ons. Loved that she called me!

7 1/26/17 Post-Interven-on Survey Pa-ent sa-sfac-on with Support Phone Call Pa.ent Quotes I loved the call! The nurse was so helpful and answered all my ques-ons. Loved that she called me! Made sure that I talked to someone because with my busy schedule I can forget. "Loved this. Really helpful. Love that you started doing this." Pa-ent Stories v Feedback from pa-ents during the support phone calls has been very posi-ve and they have verbalized being thankful and apprecia-ve of the support, even if they didn t have a specific concern at that -me. v We have many stories of pa-ents who we have been able to support early in their postpartum care, which has made a difference in quickly iden-fying issues and improving pa-ent outcomes. The nurse was super suppor-ve and gave me a lot of informa-on on breas=eeding. It was very informa-ve and helpful. Nice that it was proac-ve- I didn t have to reach out. It felt nice knowing that they cared how it was going and to feel like I had resources if I needed them. Very helpful. So nice to have someone reach out those first few days. Recommenda-ons for Support Phone Calls- Crea-ng a team Ø Create a Postpartum and Breas>eeding Support Hub to provide support phone calls to all pa-ents who deliver at the hospital/care system. Ø Team could be staffed with RNs and Lacta-on Consultants to provide versa-lity care in the support given to pa-ents. Ø Include team members with diverse backgrounds culturally appropriate care and support for our diverse pa-ent popula-on. Ø OR Ø Create a Nurse Educator/Support role at clinic sites to provide support phone calls to pa-ents who deliver at each site. Ø Role could also provide prenatal and breas=eeding educa-on during prenatal visits; Ø Onsite breas=eeding and postpartum support to answer ques-ons/ address concerns when pa-ents are in clinic or if providers have ques-ons. Recommenda-ons for Pa-ent Educa-on Ø Con-nue to enhance breas=eeding educa-on and support in our prenatal and postnatal educa-on curriculum and materials. Ø Recommend using a Newborn Feeding Plan to help standardize and facilitate breas=eeding educa-on conversa-ons between provider and pa-ent. Ø Provide educa-on opportuni-es for Providers and Nurses that focus on breas=eeding support and early iden-fica-on of concerns. 7

8 1/26/17 Ques-ons? Thank you for attending our session and supporting moms and babies! 8

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