The Path Towards Baby-Friendly: Navigating the Game Board

The Path Towards Baby-Friendly: Navigating the Game Board Krystal Revai, MD, MPH, FABM Patrice Perez, RN, BSN, MS, APN, IBCLC Eileen Murphy, RN, BSN, IBCLC, RLC

Baby-Friendly Designation Process: Development Phase Krystal Revai, MD, MPH, FABM

MDC Multidisciplinary Baby-Friendly Committee Policy Subcommittee (Step One) Training Subcommittee (Step Two) Practice Subcommittee (Steps Four- Nine) Continuity of Care Subcommittee (Steps Three & Ten) Marketing of Breastmilk Substitutes 3

Policy Subcommittee (Step One) Written Breastfeeding Policy Write or rewrite your breastfeeding policy Must address all 10 steps Several templates are available (BF USA, ABM, New Jersey) so no need to re-invent USE THE CHECKLIST Review other policies 4

Policy Subcommittee (Step One) Involve/inform other department heads such as Pharmacy, Dietary, Medicine, and ER Determine plan for dissemination of policy to all hospital staff Decide on which summary of the policy for posting in key areas serving mothers and babies to be used 5

Training Subcommittee (Step Two) Train all staff (Prenatal, L&D, postpartum providers and staff) Develop a plan to provide the necessary training Several options available, review which is best for your situation, take advantage or online or LMS if available Develop training schedule 6

Practice Subcommittee (Steps Four-Nine) Step Four Help mothers initiate breastfeeding within 1 hour of birth (skin to skin). Step Five Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants. Step Six - Give newborn infants no food or drink other than breastmilk, unless medically indicated. Step Seven - Practice rooming-in. Step Eight - Encourage breastfeeding on demand. Step Nine - Give no artificial teats or pacifiers. 7

Practice Subcommittee (Steps Four-Nine) Examine current protocols/procedures for each step Prepare new or revised protocols/procedures as necessary Examine current staff practices related to breastfeeding education and assistance for mothers Revise and/or develop inpatient education plans 8

Practice Subcommittee (Steps Four-Nine) Identify facility challenges and solutions for implementing these plans Decide on method for implementation Develop a data collection plan 9

Practice Subcommittee (Steps Four-Nine) Step Four Help mothers initiate breastfeeding within 1 hour of birth (skin to skin). Step Five Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants. Step Six - Give newborn infants no food or drink other than breastmilk, unless medically indicated. Step Seven - Practice rooming-in. Step Eight - Encourage breastfeeding on demand. Step Nine - Give no artificial teats or pacifiers. 10

Continuity of Care (Steps Three & Ten) Step Three - Inform all pregnant and postpartum women about breastfeeding. Review all educational materials provided to pregnant and postpartum women by the facility. Evaluate if all required topics are covered. Evaluate if all are they are all current, evidenced-based. Evaluate if all they are all free from commercial interests. Review and revise as necessary all materials given to pregnant and postpartum women. Review timing of prenatal breastfeeding education. Consider a method for documenting education. 11

Continuity of Care (Steps Three & Ten) Step Ten - Foster the establishment of breastfeeding support groups. Identify community organizations and practitioners that interact with pregnant and postpartum women who deliver at the facility. Survey them to determine the types of information they provide to pregnant and postpartum women about breastfeeding. Inviting them to participate. 12

INTERNATIONAL CODE OF MARKETING OF BREASTMILK SUBSTITUTES Review infant feeding and vendor policies. Develop a plan to identify and remove all promotional items, educational items provided by manufacturers/distributors of breastmilk substitutes. Develop a plan for determining accurate amount of infant formula currently utilized within the facility. Work with receiving/material management to develop a plan for acquisition and dissemination of formula under the new policies. 13

Last Step Submit breastfeeding policy, work plans, and training plans to Baby- Friendly for feedback and approval to move on to Dissemination phase. 14

Baby-Friendly Designation Process: Dissemination Phase Patrice Perez, RN, BSN, MS, APN, IBCLC

Dissemination Game Board Path Steps Train Staff Collect Data 16

Train Staff Determine most efficient and cost effective measures to execute the objectives of the 20 hour class. 17

Options Online education Learning packets Individual education, seminars, CLC 18

Must you use/purchase the curriculum? NO! 19

Must you demonstrate and have documented 20 hours of education inclusive of the UNICEF/WHO identified sessions and 5 hours of supervised clinical experience for nursing staff? YES! 20

Must MD s, CNM s and APN s providing direct patient have 3 hours of documented education? YES! 21

Document Education Personnel file LMS reporting Check list 80% must demonstrate having competed the education/competencies 22

Techniques in process at UIHHSS Scripting Unified written materials- branded items are not acceptable Review of documentation-where will all of this be charted Ability to capture required items LMS for competencies, education, record keeping 23

Collect Data EMR Manual Collection 24

25 TJC/BF requirements

26 Collection Tool Sample

Collection Tools/Documentation Many examples are given in the literature and in materials. Must reflect knowledge and practice of the required elements: Teaching of formula prep Discussion of benefits Exclusivity Manual expression STS Rooming-in. 27

Support Groups Create or provide access to, list of available support groups/resources 28

Don t forget! Purchasing of formula Compliance with the International Code of Marketing: No branded material No reps No samples No materials promoting breastmilk substitutes, pacifiers, bottles, nipples displayed anywhere. 29

It s never too early to start thinking about how you can best execute these requirements. Take away: Like Nike-Just do it. There will be kinks to work out and the sooner you start, the faster it becomes the culture! 30

Baby-Friendly Designation Process: Designation Phase Eileen Murphy, RN, BSN, IBCLC, RLC

The Pathway to Baby-Friendly Designation Dissemination Collect Data QI Plan Readiness Interview Baby-Friendly Designation On-Site Assessment Train Staff Designation Data Collection Plan Prenatal/Postpartum Teaching Plans Staff Training Curriculum Hospital Breastfeeding Policy Start Discovery Development BFHI Work Plan Register with Baby-Friendly USA CEO Support Letter Self Appraisal BF Committee Or Task Force For more information go to www.babyfriendlyusa.org Baby-Friendly USA 2010

Process overview What sort of support What are the barriers What were the easiest things to do 33

Baby-Friendly USA Baby-Friendly USA, a not-for-profit organization, was incorporated in 1997 to carry forward the implementation of the BFHI. Current Status of the US BFHI 153 designated Baby-Friendly hospitals and birth centers 34

To attain Baby-Friendly designation a birth facility: Implements the Ten Steps to Successful Breastfeeding Invites a Baby-Friendly survey team when it is determined that the Ten Steps are in place. Undergoes an on-site survey looking at the knowledge and practice of staff and the experience of mothers and babies 35

Ten Steps: Our Experience Support Barriers Easiest 36

Step One Have a breastfeeding policy that is routinely communicated to all health care staff. 37

Step Two Train all health care staff in the skills necessary to implement this policy. 38

The Past, Present, and Future Networking University of Chicago Perinatal Network. Chicago Region Breastfeeding Task Force. Hospital Breastfeeding Council of Metro Chicago. Women, Infants, & Children. 39

Step Three Inform all pregnant women about the benefits and management of breastfeeding. 40

Healthy Start Obstetrics LCMH Peer Counselor provides prenatal education on Breastfeeding Management and Baby Friendly hospital practices to all our clinic patients. Dana Posley, PC,CLC 41

90 LCMH HSO Breastfeeding Initiation Rate 80 70 60 50 40 30 20 10 0 42 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Dec-12

Step Four Help mothers initiate breastfeeding within one hour of birth. 43

Skin to Skin Promotion of skin-to-skin contact for all moms and babies at delivery and beyond. 44

Step Five Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants. 45

Step Six Give newborn breastfed infants no food or drink other than breast milk, unless medically indicated. [The requirement to purchase formula is a sub-step of Step 6.] 46

WHO Code 1981 International Code of Marketing of Breast-milk Substitutes The Code is referenced in and supported by the BFHI. 47

Step Seven Practice rooming-in and allow mothers and infants to remain together twenty-four hours a day. Picture Reference Healthy Places Grant 48

49 Promotion of rooming in for all moms and babies

Step Eight Encourage unrestricted breastfeeding. 50

Step Nine Give no pacifiers or artificial nipples to breastfeeding infants. Picture Credit: Noodle Soup 51

Step Ten Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birthing center. 52

Family Attendance 500 Breastfeeding Support Group 450 400 350 300 250 200 150 100 50 0 2007 2008 2009 2010 2011 2012 53

Reasons to Go Baby-Friendly Recognized symbol of World Class Care Deliver patient-centered care Improve health outcomes for mothers and babies Improve patient satisfaction Increase market share Elevate the reputation and standards of the birthing facility 54

Reasons to Go Baby-Friendly Demonstrate a commitment to quality improvement Build leadership and team skills among staff Improve m-pinc scores as rated by the Center for Disease Control Meet Joint Commission maternity care standards for exclusive breast milk feeding Lead the way to achieving Healthy People 2020 goals for breastfeeding 55

Population Health Outcomes Associated with Implementing the BFHI Increased: Breastfeeding initiation Breastfeeding duration Duration of exclusive breastfeeding 56 Special thanks for reference materials to Baby-Friendly USA, Inc.

57 Breastfeeding Initiation

Thank you! Current ICAAP staff for We Choose Health: Mary Elsner, Director of Obesity Prevention Initiatives at ICAAP melsner@illinoisaap.com 312/733-1026 ext.220 Scott Allen, Executive Director at ICAAP sallen@illinoisaap.com 312/733-1026 ext.202 58