Spectrum Health Grand Rapids: A Leadership Perspective in the Journey Towards Baby Friendly Laurel Jander, BSN, RN, NE-BC Nurse Manager 1 Disclosure Disclosures I do not have any financial, professional or personal conflict of interest (self or family). I do not have a significant financial interest or other relationship with the manufacturers of any products or providers of services discussed in my presentation. My presentation does not include discussion of any investigational or off-label use(s) of a commercial product or device. 2 Objectives After attending this presentation 1. The conference participant will be able to verbalize the reasons why Women s and Infant Services decided to begin the journey towards Baby Friendly. 2. The conference participant will be able to explain how the leadership team of Women s and Infant Services implemented the 10 Steps to Successful Breastfeeding using the 4D pathway. 3. The conference participant will be able to list 3 successes and challenges that Women s and Infant Services encountered in the journey. 3 PPT Demonstration_CA_050508 1
Grand Rapids, Michigan Grand Rapids, Michigan Spectrum Health Largest health care system in West Michigan 11 Hospitals Regional Hospital serving a population of 575,000 state-wide Largest employer in West Michigan with 21,000 employees PPT Demonstration_CA_050508 2
Women s and Infant Services Delivers the largest number of babies in Michigan 7600 births/year 420 nursing staff, 80 obstetricians, 100 pediatricians 7 Floors OB Triage L&D (2) Postpartum (2) High Risk Antepartum Gynecology/Postpartum Baby Friendly Hospital Initiative 8 Michigan: Breastfeeding Initiation Rates 1. Idaho 91.8 2. California 91.6 3. Oregon 90.2 4. Colorado 89.1 5. New Hampshire 88.5 30. Michigan 74.6 50. Kentucky 52.6 51. Mississippi 50.5 9 PPT Demonstration_CA_050508 3
Michigan: Breastfeeding 6 Month Rate 1. Idaho 74.5 2. California 71.3 3. Oregon 71.0 4. Hawaii 64.9 5. Utah 64.2 32. Michigan 45.1 50. Arkansas 24.2 51. Mississippi 19.7 10 Michigan: Exclusive Rates at 3 Months 1. Idaho 60.3 2. California 56.8 3. Massachusetts 55.7 4. Oregon 64.9 5. South Dakota 64.2 30. Michigan 34.3 50. Tennessee 17.9 51. Mississippi 17.0 11 Michigan: Exclusive Rates at 6 Months 1. California 27.4 2. Idaho 27.0 3. Alaska 26.8 4. South Dakota 26.3 5. Vermont 25.9 41. Michigan 13.0 50. Mississippi 5.1 51. Tennessee 4.1 12 PPT Demonstration_CA_050508 4
Michigan: % Births at Baby Friendly Facilities 1. Maine 28.2 2. New Hampshire 27.3 3. Connecticut 25.0 4. California 24.8 5. Alaska 21.7 - Michigan 0.55 13 Mission Statement To Improve the Health of the Communities We Serve. How does Women s and Infant Services make an impact? Breastfeeding mothers and babies increase the health of the community What is our impact? 7,600 births per year= 15,200 lives we can change in one year We can make a difference! Is it going to be for the better? Yes! Other Motivators: Joint Commission Requirements for exclusive breastfeeding CDC Breastfeeding Report Card mpinc Maternity Practices in Infant Nutrition and Care Score American Academy of Pediatrics Etc. etc. etc. IT WAS THE RIGHT THING TO DO! 15 PPT Demonstration_CA_050508 5
Baby Friendly Hospital Initiative How we got started. What: Nationwide quality improvement initiative Who: 90 selected teams from around the United States; 9 hospitals from Michigan When: July 2012 to Sept 2014 Partners: CDC, Baby-Friendly USA How: monthly teleconferences, data collection/sharing, 3 conferences, web platform to share tools for success First Steps Discovery D1 Paperwork Self Appraisal Formula Pricing Estimate Executive Sponsor PPT Demonstration_CA_050508 6
Next Steps Development D2 Task Force Quality Measures Policy The Plan Know yourself! You have to know where you are in order to best determine where you need to go!! COLLECT YOUR DATA!! 20 Quality Measures Process Measures Skin to skin BF in 1 hour Prenatal Ed Assistance with BF Rooming In Community Support Outcome Measures Exclusive Breastfeeding Rate Supplementation Rate PPT Demonstration_CA_050508 7
THE PLAN Communication What is Baby Friendly? Why are we doing this? Education 20 hours staff education 3 hours physician education PDSA cycles Physician newborn exams in rooms Hearing screens all newborn testing in rooms Big Change Dissemination D3 February 2013 Moved to D3, Dissemination Phase Completed 4 successful PDSA cycles Staff and Clinic Pediatricians doing newborn care in the room March 2013 New Postpartum Unit Opened Baby Friendly Model of Care implemented on the new unit Baby Friendly Model of Care No more handing out diaper bags Budgeted for and purchased safe sleep sacks to give at discharge No more free stuff from formula companies Began purchasing formula and stocking in Pyxis machines No longer a traditional nursery Changed the name to Newborn Observation Unit No routine separation of mother and baby Newborn care was now done at the bedside when at all possible No routine pacifier use Followed AAP guidelines for pacifier use in the newborn No infant feeding schedules Began infant-led feeding; feed by feeding cues No routine supplementation Promotion of Exclusive Breastmilk feeding PPT Demonstration_CA_050508 8
Removing Diaper Bags No More Diaper Bags How We Did It Halo Sleep Sacks Formula and Supplies went in to Pyxis How we paid for it Repurposed money Each sleep sack costs $6.75 with the Spectrum Health logo Feedback from patients Most patients didn t even notice Some parents still come in with the coupon for the bag Paying for Formula How to Use the Baby Friendly Calculation Worksheet Takes some time, but it is not difficult How much Not as much as we thought! Fair Market Value is different everywhere (state to state, city to city) 26 Paying for Formula Fair Market Value Formula Pricing Worksheet Facility Retail Percent Description Cost Cost Discount PAMPERS SWADDLERS 0.06 0.33 82% PROMISE PADS 0.14 0.35 60% NIPPLE SHIELDS 24 MM 3.35 9.99 66% TOOTHPASTE 0.23 1.29 82% BABY SHAMPOO 0.29 1.39 79% Avg Discount 74% Retail Formula Cost/Ounce $0.43 Discount (74%)/ounce $0.32 Fair Market Value= Retail Cost Discount $0.11 Retail Nipple Cost 0.84 Discount (74%)/nipple $0.62 Fair Market Value= Retail Cost Discount $0.22 Yearly Formula Quantity and Cost # Births/ year 7400 Projected Excl BF Rate 80% Projected Form Feed Rate Excl Rate 20% Estimated Formula Fed infants/year 1480 Average Infant Birth Weight 8.5 Average Formula Consumption per infant 17 Average hospital stay per infant 2.5 Estimated # Formula Ounces per infant 42.5 Estimated # Ounces of Formula per year 62900 Formula Cost/Year at Fair Market Value $6,919.00 # Nipples per year 37000 Nipple Cost/Year at Fair Market Value $8,140.00 27 PPT Demonstration_CA_050508 9
Newborn Observation Area 28 Educating the Masses Nurse Education Two 4 hour classes Two 3.5 hour online sessions One 5 hour small group competency Be Creative Pocket Guides Questions of the Week 29 30 PPT Demonstration_CA_050508 10
Educating the Masses Physician Education- take every opportunity OB City Wide Continuing Education Program OB Monthly Business Meetings Pediatric Grand Rounds Family Practice Section Meetings Wellstart International s Lactation Management Self Study Modules (3 hours) What do your physicians need to hear? 31 Educating the Masses Nurse Technicians Office Staff Hospital Wide Community 32 Biggest Challenges 1. Policy 2. Educate Staff 3. Prenatal Education 4. Skin to Skin, BF in 1 hour 5. Assist with BF, even with separation 6. Exclusive Breastmilk Feeding 7. Rooming In 8. On Demand Feeding- Feeding Cues 9. No pacifiers 10. Support Groups 33 PPT Demonstration_CA_050508 11
Rumor has it. Spectrum Health doesn t have a nursery anymore. There are more babies getting dropped since we started Baby Friendly. All the patients are upset about Baby Friendly and will go to other hospitals in the future. Patients will have to bring in their own formula. Spectrum Health doesn t have pacifiers anymore. Nurses make mothers keep their baby in the room. Damage Control Call in reinforcement Bobbi Philipp- our hero! Strategic Plan for Rest Promotion Decrease interruptions Limit visitors Customized rest time Infant Safety Plan Safe Sleep- Crib Caution Signs Standardized skin to skin practice 2 Safety Information/Consent Prenatal Clinic Get started early Include clinic leadership in Task Force Educate clinic staff Develop a curriculum Persist Insist Do Not Desist 36 PPT Demonstration_CA_050508 12
Prenatal Curriculum- more than handouts Ask Me About Baby Friendly 37 Celebrations World Breastfeeding Week Candy never fails to engage- Celebrate Milestones in Quality Measures Just for fun 2 World Breastfeeding Week 2 PPT Demonstration_CA_050508 13
Best Fed Jeopardy 2 Outcomes 2 Outcomes 2 PPT Demonstration_CA_050508 14
Outcomes 2 What some of our Patients Started to Say This experience was so different than with my first baby. I was so happy that I got to keep the baby in the room with me the whole time. Very relaxing & allowed plenty of bonding time after birth. Being able to have our baby in the my room and being able to ask any nurse for help- this was the best part of my stay! The staff pediatricians were wonderful! I appreciated them coming to my room each day. Very informative! I loved having time after my c- section with my baby and husband. It was quiet, calm and comfy. This was a much better experience than with my first daughter because I felt like I went home knowing how to handle the crying in the middle of the night better. I had babies in 2004 & 2009 and it seems like the nurses staff have made a GREAT improvement since then. I appreciate all they did for me and as an employee of SH I can say that I am proud to work for an organization that takes such good care of their patients. Mock Baby Friendly Site Visit Lessons Learned Start working with prenatal clinics early Get physicians in line- they will be asked the hard questions! Have a plan for the day Don t be discouraged Invite someone to do a mock visit- practice makes perfect PPT Demonstration_CA_050508 15
Next Big Steps were. Scheduling Baby Friendly Site Visit Fall of 2014 Baby Friendly Questions of the Week Weekly Rounding Physician Preparedness Simulation of Survey Interview Quiz Show Prenatal Clinic Intense focus on curriculum and patient interviews Site Visit Quantitative and Qualitative Interviews with: CEO Senior nursing administrator Nurse manager, Prenatal Services Unit managers Educators Purchasing agent Baby Friendly Task Force Interviews of randomly selected key informants: Health care providers with privileges on maternity Nursing staff (all shifts) Pregnant woman, >32 weeks gestation Mothers with vaginal delivery Mothers with cesarean delivery Mothers of babies in NICU/SCU Examination of: Infant feeding policy and other standards Prenatal education curricula Staff training curricula Educational materials given to patients Discharge packs Posted documents and media Medical records Vendor invoices for formula and related feeding equipment Random observations throughout the survey of: Staff competency with breastfeeding teaching Birth practices Location of babies on the unit Mothers feeding competency Visible messages about infant feeding Designation D4 We had our site visit in September of 2014 and 48 PPT Demonstration_CA_050508 16
Spectrum Health We are now one of the largest birthing centers in the United States to have received the Baby Friendly Designation!! 49 We Don t Always Perceive Things the Same Way But Working Together Will Help Accomplish Your Goals PPT Demonstration_CA_050508 17
Make the Most of the Resources You Have Consult With Your Team Expect the Unexpected PPT Demonstration_CA_050508 18
Never Give Up! Celebrate Every Success Cut a ribbon, cut a cake. Dr. Bobbi Philipp And Remember, It Always Seems Impossible PPT Demonstration_CA_050508 19
Until It Is Done The End Questions?? 60 PPT Demonstration_CA_050508 20