Baby-Friendly Initiative Sustainability

Transcription

1 Baby-Friendly Initiative Sustainability Tool 2017

2 Maintaining Your Baby-Friendly Designation Congratulations on achieving your Baby-Friendly Initiative (BFI) designation! Planning sustainability is vital to long term maintenance of best practices and ongoing quality improvement. Facilities need to be BFI re-designated every 5 years. Ongoing maintenance ensures best practices are kept up and prevents the need for intensive work just ahead of your next assessment for BFI re-designation. Requirements for BFI designation are set by the Breastfeeding Committee for Canada (BCC) and can be accessed at In addition to this document, refer to the BFI Implementation Toolkit, chapters 8 and 9, for maintaining BFI designation requirements, challenges and suggestions. This BFI Strategy for Ontario resource can be found at Continuous maintenance in the following areas will help organizations meet BFI designation requirements set out by the BCC and strengthen a Baby-Friendly culture. Self-assessment Self-assessment will ensure BFI standards are maintained, with concerns and gaps identified and addressed on an ongoing basis. Use the BFI 10 Steps and WHO Code Outcome Indicators for Hospitals and Community Health Services (BFI 10 Steps and WHO Code Outcome Indicators) as your self-assessment tool found at Consider the following strategies. Continue regular (for example, monthly) BFI multidisciplinary committee meetings. Support and review the role of the BFI lead(s) in your organization. Review and complete the self-assessment tool regularly. Depending on your facility, this may be a semi-annual or annual comprehensive review completed by the BFI multidisciplinary committee, BFI lead, Quality Council, or management team. Review and update policies, documents, media resources and websites to ensure information is accurate, consistent and current. This may be done annually or as determined by the organization or BFI multidisciplinary committee. Undertake routine environmental scans to ensure compliance with the International Code of Marketing of Breast-milk Substitutes (The Code). Develop a plan(s) to address the concerns and gaps identified during your self-assessment. Decide who will be responsible for specific tasks, and implement creative ways to effect change and evaluate outcomes. Celebrate your changes and successes and plan strategies for maintaining them. Data review BFI designated facilities should continue to review breastfeeding data to identify areas of strength and areas for improvement. Celebrate as targets are achieved to encourage ongoing momentum. 1

3 Reviews may include: Breastfeeding rates Monitoring rates of breastfeeding initiation, exclusivity and duration helps to identify areas of concern and develop targeted strategies to address improvement opportunities. Monthly, semi-annual or annual reviews can identify ongoing progress. Transparency to all members of the multidisciplinary team keeps everyone engaged to support best practice standards. Carefully consider unintended impacts of strategies. For example, if implementing education on appropriate medical supplementation, you may closely monitor jaundice rates to see if there is an unintended impact. Supplementation rates Documenting and auditing the reason for supplementation will help organizations monitor medical and non-medical supplementation rates. Develop strategies to address areas of concern. Consider the following tools to review data Better Outcomes Registry & Network (BORN) Ontario data Hospitals can audit their own BORN data to monitor BFI performance indicators defined by BCC. This data can be used to tease out specific areas of concern that may be effecting breastfeeding or supplementation rates. Once issues are identified, strategies can be developed to address the concerns or gaps. Chart audits Review documentation to collect data and identify gaps, for example, medical/ non-medical supplementation rates. Surveys/Questionnaires Eliciting feedback from stakeholders may identify or clarify specific areas of concern and opportunities for change. When developing surveys, it may be helpful to consider questions from Appendix E- Questionnaires. Engaging experts Partnering with the decision-support department or epidemiologists from within your organization or community can support data analysis to identify concerns, gaps and opportunities in specific areas. Assess satisfaction and compliance with ongoing BFI best practice standards Successful implementation and ongoing support of the BFI 10 Steps and WHO Code Outcome Indicators includes the involvement of all health care providers (HCPs), support staff and patients/ clients. A regular process to gather and monitor feedback provides opportunity to identify gaps and areas where improvement is needed. Strategies may include: Patient/client satisfaction audits Identify areas where patients/clients are well supported as well as areas for improvement. Satisfaction rates can be collected through existing mechanisms such as a hospital post-discharge phone call or by targeted surveys. Periodic surveys of women accessing a service such as a breastfeeding clinic or an inpatient service, may identify areas of satisfaction or concern.* HCP satisfaction audits Identify and respond to the concerns of HCPs to improve compliance to best practice standards, productivity, increased workplace satisfaction and improved patient/client care. Strategies may include: Quality assessment bulletin boards posted in a staff area to communicate new strategies, procedures and policies for the staff to review. Quality assessment cards/tickets completed by HCPs to identify concerns and to propose solutions. This gives HCPs an opportunity to actively participate and promote positive change. The concerns and recommendations may be reviewed by the BFI multidisciplinary committee, Quality Council, management team or at staff meetings. Targeted surveys that focus on a particular practice, identifying the concerns and solutions, for example, implementation of infant pain reduction strategies for painful procedures.* * If developing a new survey, organizations are encouraged to engage appropriate experts (epidemiologists or Research Ethics Boards) to ensure data collection and analysis is in line with best practices and ethics standards. 2

4 Education of HCPs to maintain BFI standards, support learning and practice changes Maintaining BFI standards, supporting practice changes with consistent messaging and ensuring all HCPs have sufficient information to meet best practice standards requires ongoing education for professionals working throughout the continuum of care. Based on identified needs, practice outcomes can be improved with appropriate education sessions or one-on-one training. At the same time these strategies may increase confidence and provide opportunities to highlight successes. Ongoing education options may include: Lunch and learn sessions. Weekly/monthly staff in-services. Standing BFI information sessions/updates for staff meetings or other staff training sessions. These sessions may be facilitated by an International Board Certified Lactation Consultant (IBCLC), other expert presenters or staff members with a particular area of interest. RNAO free online Breastfeeding e-learning course with a certificate available upon completion ( Best Start Resource Centre free online Healthy Mothers, Healthy Babies Breastfeeding course with a certificate available upon completion ( BFI 101 E-Learning free online course with a certificate available upon completion ( Breastfeeding/BFI conferences. Mock/practice BFI assessment strategies. Education newsletter to HCPs. Breastfeeding Resources Ontario for resources to support practice changes ( 3

5 To maintain current education: Ensure all new direct care staff members have completed the 20-hour breastfeeding course or equivalent within 6 months of hire. Ensure all staff members have received education and know how to support a formula feeding family while protecting practices that support and promote breastfeeding. Develop BFI champions to support, teach and advocate for BFI best practices. Mentor medical residents and other health care students, including midwives and nurses, to champion BFI implementation by protecting, promoting and supporting breastfeeding. Support and strengthen BFI throughout the organization Ensure that BFI continues to be in the forefront throughout the organization. This will solidify practices and strengthen a culture that protects, promotes and supports breastfeeding. Consider the following strategies. Incorporate the breastfeeding policy into the organization-wide orientation. Regularly offer or facilitate access to the BFI 20-Hour Breastfeeding Course. Celebrate National Breastfeeding Week yearly. Provide ongoing BFI updates to non-direct care providers and volunteers. Evaluate and respond to concerns identified in areas of the organization that have contact with mothers/infants, for example, medical imaging, laboratory, emergency department, surgical and medical units, Intensive Care Unit, gift shop, retail pharmacy and waiting rooms. Evaluate compliance with policies and identify where additional support, education or changes may be required. Communicate BFI ideas, tips or suggestions within the organization regularly to strengthen and support a positive breastfeeding culture. For example, this may be done through newsletters or s. Inform all staff members prior to their (or their partner s) maternity leave of their right to have support to continue breastfeeding or expressing breast milk for their child upon returning to work. This will enable them to develop a plan to continue breastfeeding and/or provide breast milk. Support breastfeeding anytime and anywhere with signs and symbols throughout the organization, including directions to a quiet place if desired. Ensure all resources within the organization are compliant with BFI and The Code. Document collection In anticipation for BFI re-designation every 5 years, it is recommended to maintain a document binder or collection of key documents as per BCC guidelines including: Updated policies. New practices that have been implemented. New patient teaching materials. Documentation or supporting evidence of education sessions completed. This will simplify the upcoming process for BFI re-designation and will expedite the document review process. Identifying one person or a small team to maintain a collection of updated and new key documents required for BFI assessment will help support this task. 4

6 Establish or strengthen a regional BFI network or coalition In alignment with Step 10 of the BFI 10 Steps and WHO Code Outcome Indicators, intentionally strengthen the continuum of care by engaging in a regional BFI network or coalition. This provides a forum for BFI designated organizations to support local partners in BFI implementation. Be a change agent by connecting with others who teach and influence families outside of your organization. Whether due to constrained resources, conflicting priorities, lack of awareness, or because they are not eligible for BFI designation, some organizations have not begun or even considered BFI. These may include local hospitals, Family Health Teams, Community Health Centres, Aboriginal Health Access Centres, prenatal education classes and other community health services. BFI designated organizations have a responsibility to take a lead to engage and offer support for partners to understand and pursue these best practice standards. Linking with these partners ensures consistent support and messaging for families throughout the continuum of care and creates a culture of best practice within the community. Consider the following strategies. Present to key stakeholders the value and importance of BFI. Encourage the use of BFI compliant education materials to increase consistency. Share key resources and offer to coach other organizations as they begin to implement BFI best practice standards. Share Breastfeeding Resources Ontario at a bilingual website that is a centralized source of quality, and evidence-based resources that support BFI. Connect with your local community and beyond Embrace opportunities to increase awareness and educate the community to promote positive culture changes. Participate in community events to highlight the benefits of BFI to the individual, health care system, environment, economy and community. Engage the local media to share stories, highlight National Breastfeeding Week and BFI best practices that improve patient care outcomes. Engage with BFI provincial organizations Gain insights and learn about resources by sharing challenges and strategies with other organizations throughout the province. Strategies may include regular engagement with: BFI Ontario, including meetings and Ask an Assessor teleconferences. More information is available at BFI Strategy for Ontario, including webinars. More information is available at Proudly celebrate your successful BFI designation. Development of this tool was funded by the Government of Ontario through the Michael Garron Hospital's BFI Strategy for Ontario. The BFI Strategy is a partnership of Michael Garron Hospital (formerly Toronto East General Hospital), the Best Start Resource Centre, and the Provincial Council for Maternal and Child Health. 5