On the Path towards Baby-Friendly Hospitals: First Steps Breastfeeding Promotion Webinar June 19, 2013 Objectives: Explain how to start planning for

On the Path towards Baby-Friendly Hospitals: First Steps Breastfeeding Promotion Webinar June 19, 2013 Objectives: Explain how to start planning for Baby-Friendly Hospital Outreach Describe the first steps for coordinating with community hospitals Identify involvement once coordination begins

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Samantha Lee, NWA Introduction Agenda Robbie Gonzalez-Dow, MPH, RD, CLE, Regional Breastfeeding Liaison for Community Bridges WIC Program, Santa Cruz County and the Executive Director of the California Breastfeeding Coalition Jeanne Kettles, MA, DEM, CLE Regional Breastfeeding Liaison, Alameda County Women Infants & Children (WIC) Program Samantha Lee, NWA Q&A Please make sure your computer speaker sound is lowered or muted to avoid echo

Jeanne Kettles, MA, DEM, CLE Alameda County WIC Program RD, CLE Community Bridges WIC Prrogram California Breastfeeding Coalition

California has 59 designated Baby-Friendly Hospitals

Parade of Baby-Friendly Hospitals

Priority of the California Department of Public Health WIC Program

POLL QUESTION 1

The Evidence The Ten Steps to Successful Breastfeeding have been demonstrated to increase both initiation and duration of breastfeeding DiGirolamo AM, LM.Grummer-Strawn and SB Fein. 2008. Effect of Maternity-Care Practices on Breastfeeding Pediatrics122;S43-S49 Merten, S, et al. 2005. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics 116; e702-e708. Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681. DiGirolamo AM, LM Grummer-Strawn, S Fein. 2001. Maternity care practices: implications for breastfeeding. Birth 28:94-100. Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA 285:413 Baby-Friendly USA, Inc. 2010 10

STEP 1 Have a breastfeeding policy that is routinely communicated to all health care staff. 11

STEP 2 Train all health care staff in the skills necessary to implement this policy. 12

STEP 3 Inform all pregnant women about the benefits and management of breastfeeding. 13

STEP 4 Help mothers initiate breastfeeding within one hour of birth. 14

STEP 5 Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants. 15

STEP 6 Give newborn breastfed infants no food or drink other than breastmilk, unless medically indicated. 16

STEP 7 Practice rooming-in - allow mothers and infants to remain together twenty-four hours a day. 17

STEP 8 Encourage unrestricted breastfeeding. 18

STEP 9 Give no pacifiers or artificial nipples to breastfeeding infants. 19

STEP 10 Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birthing center. 20

Questions

We ve been through a few changes

Competing QI Priorities of Hospital Breastfeeding might not be at the top of the list just saying Frame the medical issue with statistical significance of best practices Relate to core strategic values and community health objectives Accreditation, patient satisfaction and standard of care

The Joint Commission Accreditation Perinatal Care Core Measure Set PC-01 PC-02 PC-03 PC-04 PC-05 Elective delivery Cesarean section Antenatal steroids Health care associated bloodstream infections in newborns Exclusive breast milk feeding

Mission is to help members provide high quality health care and to improve the health status of the communities they serve Bring hospitals together to achieve excellent patient care and community health far beyond the capacity of individual hospitals

Mentoring and technical assistance to hospitals for perinatal QI measures Develop communication networks among agencies, providers, and individuals to exchange information Promote access to appropriate levels of high quality care. Funding is provided by Federal Title V MCH Block Grant Funds

Institute for Healthcare Improvement Bring together teams from different hospitals to seek improvement in specific topic areas Provide structure for organizations to learn from each other and from recognized experts

REGIONAL BREASTFEEDING QI TASKFORCE Perinatal Hospitals of Alameda County and Contra Costa County

Effective hospital QI involves collaboration among institutions Why a Taskforce? Accelerates circulation of existing knowledge Provides insight into how centers with the best outcomes are able to implement successful changes that improve outcomes Moral support!

Purpose Convene multidisciplinary breastfeeding quality improvement teams from perinatal hospitals throughout Alameda County and Contra Costa County to collaborate on resource sharing and systems development to improve exclusive breastfeeding rates and health equity. If you want something you ve never had before You ve got to do something you ve never done before

Effective QI Teams Three different kinds of expertise within the organization: system leadership technical expertise day-to-day leadership There may be one or more individuals on the team with each kind of expertise, or one individual may have expertise in more than one area, but all three areas should be represented in order to drive improvement successfully - Institute for Healthcare Improvement

Multidisciplinary Quality Improvement Team Including the right people on an improvement team is critical to a successful improvement effort. Lactation Specialist(s) Education and Lactation Nurse Practitioner Clinical Nurse Specialist(s) Nurse Manager(s) Pediatricians Neonatologists Obstetricians Family Practice Physician Former Patient Midwifery/OB Director Clinical Director(s) Unit Manager(s) Coordinator of Childbirth Program Director Clinical Education and Development Risk/Quality Management Hospital CEO/COO Community Relations Dietitian

Journey together begins Attending the CA Breastfeeding Summit Building multidisciplinary hospital breastfeeding committees SOFT approach to implementing practices to support breastfeeding Regional data and hospital data collection methods; using data to focus action planning

Maternal Practices in Infant Nutrition and Care (mpinc) Labor and Delivery Postpartum Care Feeding of Breastfed Infants Breastfeeding Assistance Contact Between Mother and Babies Family Discharge Planning Staff Training Structural/Organizational Aspects of Care

mpinc Scores Low (<60) Moderate (60-79.9) High ( 80) Regional composite score (72) on par with California composite (73) Detailed explanation of mpinc scoring at www.cdc.gov/mpinc

Strongest Care Dimensions Breastfeeding Assistance (94) Feeding of BF Infants (88) pacifier use (17) supplemental (0)

Moderate Dimensions Labor & Delivery (73) Organizational Aspects of Care (70)

Labor & Delivery (73) Skin to skin (50) Routine procedures performed skin to skin (0) Organizational Aspects of Care (70) Facility does not receive infant formula free of charge (0) BF Policy includes all 10 model policy elements (17) Breastfeeding support for employees (50) Documentation of infant feeding patient pop (50)

Weakest Dimensions Staff Training (35) Facility Discharge Planning (57)

Discharge planning and community collaborations to achieve breastfeeding quality measures

Guidelines for competencies best practices in assessment and development

Curriculum development for staff training that meets BRHI standards

Fostering administrative support for breastfeeding QI

Hospital Council encouraging participation from Chief Operating or Administrative Officers Directors Quality/Quality Improvement Managers Medical Staff Services Directors Directors OB/PED Directors MCH Nursing Clinical Nurse Specialists/Nurse Managers OB /PED Directors Education and Training Physicians OB and PED Nurses L&D/AP, NICU

Conversations and Connections Public Health Officer Panel of Community Partners Health Care Provider Education Diana H. Mahar MD, MSc, IBCLC Chapter Breastfeeding Coordinator (CBC) American Academy of Pediatrics, No.California Chapter

WIC / Hospital Collaborations WIC on the Breastfeeding Committee Local Agency Directors, Breastfeeding Coordinators, Peer Counselors WIC/Hospital/Community Clinic Forums Series of meetings to address consistent messaging and referrals

Celebrating success along the way!

LOI Baby Friendly!

RBQIT helps us to build the fire and passion by giving us tools and resources to bring back to my facility that affect real changes towards Baby Friendly. For example our implementation of the Golden Hour with skin to skin, and clarifying our supplementation protocols. (Eden Medical Center) The Taskforce helped us develop our BF committee and understand who should be involved and how to get their buy in for change. For years it was just ME! Now we hired another IBCLC, we have a policy, and we ve locked up the formula in the PYXIS! (Sutter Delta)

Taskforce participation has given us ideas on how to get Administrative buy in which we have struggled with! It motivates our hospital team to keep going! (Contra Costa Regional Medical Center) We are learning about standards of care at other hospitals in the community and bringing the information back to our manager. It s great to learn about how we can do our own education and also hear about educational opportunities in the community. (Valley Care Medical Center)

It s sharing and networking to learn what is going on at different facilities and services offered for our patients especially WIC! (Sutter Delta)

The systems within which your hospitals work and receive QI support are resources for advancing breastfeeding by bringing administrators and quality engineers on board in partnership with WIC. Consider the hospital/systems core strategic values and community health objectives. Relate these to the medical issues from sub-standard care. Use WIC data to demonstrate need. Promote opportunities to bring hospitals together especially those that have achieved Baby Friendly with those that are striving for it.

Questions

Goal: Watsonville Community Hospital will take steps to implement the Baby-Friendly Hospital Initiative to improve maternity care policies and practices that support exclusive breastfeeding.

Santa Cruz Co. Breastfeeding Rates 2011 Hospital Breastfeeding Rates Compared to Healthy People 2020 Objectives Any BF Formula Supplementation of BF 98.7 98.8 97.2 81.9 44.3 14.2 7 7.8 Healthy People 2020 Objectives Sutter Dominican Watsonville

Santa Cruz Breastfeeding Coalition

Weekly Meetings

WIC Site Visit

WIC Hospital WIC Site Based Visit Support Group

WIC Site Visit

Pediatric Physician Meetings

OB Physician Meetings

Maternity Care Staff Meetings

Education and Training

Registered with Baby Friendly USA Completed the Self Appraisal Tool

Obtained CEO Support Letter

Convened the Baby-Friendly Task Force

Building Relationships and Partnerships

Questions

POLL QUESTION 2

Answer in the chat box What is your next step towards creating Baby-Friendly environments in your community?

For more information please contact: Jeanne Kettles, MA, DEM, CLE Regional Breastfeeding Liaison Alameda County Women Infants & Children Program Jeanne.Kettles@acgov.org (510) 393-9632 Robbie Gonzalez-Dow, MPH, RD, CLE Regional Breastfeeding Liaison Santa Cruz County Community Bridges Women Infants & Children Program Executive Director, California Breastfeeding Coalition robbieg@sccwic.org or robbiegd.cbc@gmail.com (831) 722-7121 x 155 or (831) 917-8939