7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

1/18

HOW WE MADE A DIFFERENCE ATWAKE MED CARY

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

2/18

IS WAKE MED CARY UNIQUE?

20102533 Births

200 (8%) births

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

3/18

WAKE MED CARY AT A GLANCE.

Nine Private Practices 2 practices have midwives Unassigned Patients are seen by one practice Six practices are solo practitioners No NICU. We have a SCN

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

4/18

WHAT WE ALL READY KNEW

Breastfeeding initiation rateswere good.

Cary has gooddemographics for

breastfeeding. Lactation support is

recognized as a satisfier inpatient satisfaction surveys.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

5/18

WHERE DID WE BEGIN?

Management made acommitment to becomeBreastfeeding Friendly.

Hospital invited toparticipate in PQCNCexclusive human milkfeeding initiative.

Invited to participate withCGBI initiative to becomeBreastfeeding Friendly.

Breastfeeding committeeformed. We meet monthly.

1st meeting was October14, 2010.

Members very enthusiastic! Members joined the group

voluntarily.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

6/18

WHAT WAS ALL READY IN PLACE?

Several local pediatricpractices with LCs on staff.

We have 2 LCs scheduled7 days per week.

We have a supportive uppermanagement team.

Lactation Consultants seeall moms intending tobreastfeed at least once,

usually more.

Warm-line One outpatient visit at no

charge for mothers whodeliver at Wake Med Cary.

Loaner pump program formoms discharged beforethe baby is discharged fromSpecial Care Nursery.

Breastfeeding Core Classesfor staff.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

7/18

GOALS

Breastfeeding Committeemade a list of goals

Committees first goal wasto make a change thatcould be measured.

Decided to start with skin toskin.

Staff presented with aneducational opportunitywith multiple choices of

when they could attend in-service. It was mandatory!

Management supportiveof goal.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

8/18

WHAT DID IT LOOK LIKE WHEN WE

STARTED?

Breastfeeding initiation rate90%

Exclusive breastfeeding rate49%

Pacifier use was 40% Skin to skin for vaginal births

70%. C/S 7%

Moms demonstrated handexpression 6%

Moms informed ofbreastfeeding support in thecommunity 49%

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

9/18

BARRIERS

Some staff resistant tochange.

Inconsistent informationgiven to moms from MD and

some staff. Negative comments. Formula reps very ingrained

in the culture at Wake MedCary (Lots of free lunches)

Open door policy forformula reps.

Cost of purchasing formula Lack of education. Staff worried that patient

satisfaction woulddecrease.

Consistency/ Buy in fromstaff

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

10/18

EDUCATION

All staff required tocomplete required amountof breastfeeding training asoutlined in the NCBFMCD.

Two day long breastfeedingcore classes every year.Educations cover all of theten steps. Updated every 2years. Staff required andpaid to attend. Staffreceive CEUs.

Staff required to shadowand LC for 5 hours . LCsavailable 7 days per week .

Deadlines for completingtraining and shadowingwere posted and discussedwith staff at staff meetingsand in staff updates.

Unit educator kept track ofemployees education andshadowing hours.

All staff were required tocomplete the University ofVirginia training on line.www.breastfeedingtraining.org

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

11/18

POLICY

Breastfeeding policy waswritten by hospital wideBreastfeeding Friendlycommittee.

Took several months towrite.. Policy approved and made

effective May 2011

Staff were all required toread policy. All staff had tosign a document statingthat they had read andunderstood the policy.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

12/18

PACIFIERS / SUPPLEMENTATION/

THE BAGS

Many staff members did notunderstand how we couldmanage without pacifiers.A handout was created to

script what the nurse shouldsay to a parent whorequested a pacifier.

Staff have been educatedon appropriate

supplementation at thecore classes.

Formula gift bagsdiscontinued Mothers Day2011. many staff fearedpatient satisfaction rates

would go down. Reality: Very few complaints.

Quite a few complimentsfrom patients whoapplauded the hospital for

making the effort tobecoming breastfeedingfriendly

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

13/18

HOW DID WE MEASURE?

One person designated asdata entry.

All dyads included in datacollection that met PQCNC

guidelines. Not just apercentage of dyads.

Printed on bright yellowpaper

Audits done on datacollection forms

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

14/18

HOW DID WE GET STAFF ON BOARD

We gave them the tools they needed to be successful. Weprovided them with education.

We listened to complaints, concerns and we reassured them. We gave them lots of positive feedback. Management restated the goals consistently. Some staff continued to complain. We listened an restated the goal of reaching 5 stars We praised and we praised and we listened and listened. Andwe did not waiver. And we gave them the GOOD results. AND WE WILL NOT WAIVER

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

15/18

SUPPORT GROUP

Started in Feb. 2012 1st meeting 3 moms and babies Most recently 20-23 WOW!

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

16/18

WHERE ARE WE NOW.

Steps 1,3,5,8,9 and 10 completed We are working on: Physician training.

Skin to Skin after C/S birth Free formula Rooming in 22 hours or more We continue to offer Breastfeeding Core Classes. The classes

are separated into basic class and advanced class.

We have a bi-annual blitz for the nursing staff. Competencybased.

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17/18

STATS NOW

Exclusive breastfeeding rates are 68% Initiation rate of 90-95% Pacifiers no longer provided by staff except for painful

procedures.

Teaching hand expression is 90% Skin to Skin after delivery 67% . Dependent upon mode of

delivery

Breastfeeding support 91% Baths are routinely delayed until baby has had a feeding.

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Wake Med Cary Example

18/18

3 STARS!!!!!!!!

AND WE

HAVE..