Safe and Healthy Beginnings

1. Safe and Healthy Beginnings Team: Asha Mandava, MD Peggy Downing, RN, Mgr Sandy Swanson, RN, AD Maureen Davey, RN, Mgr Pam Allyn, RN, IBCLC Pat Karczyewski, RN, IBCLC Magnet Forces: Quality of Care (6), Quality Improvement (7), Consultation and Resources (8), Community and the Hospital (10), Nurses as Teachers (11), Interdisciplinary Relationships (13) Confidential: For Quality Improvement Purposes Only

2. Project Background The American Academy of Pediatrics selected 10 hospital nurseries and 12 primary care practices to participate in a Quality Improvement Innovation Network (QuIIN) to improve care and outcomes for children by testing practical tools, measures and strategies for use in every day practice. The Safe and Healthy Beginnings QuIIN focused on care issues specific to Normal Newborns. Loyola identified two opportunities: 1. The care of newborns at risk for hyperbilirubinemia 2. Enhanced breastfeeding initiation and support References: Management of Hyperbilirubinemia in the Newborn Infant 35 Weeks or More of Gestation, July 2004, Pediatrics Breastfeeding and the Use of Human Milk. AAP Policy Statement, February 2005, Pediatrics Confidential: For Quality Improvement Purposes Only

3. Our Project Aim To ensure safe and healthy beginnings for all Loyola newborns related to two specific potential newborn problems by: Hyperbilirubinemia Breastfeeding • 100% of breastfed infants will: • latch within the first hour of birth if eligible • have 2 documented formal assessments of breastfeeding daily, • be discharged to mothers who have been provided counseling and community resources for follow-up support • 100% of infants will have: • documented risk assessment • presence or absence of jaundice assessed at discharge • a follow-up appointment within 2 days of discharge if high risk Confidential: For Quality Improvement Purposes Only

4. Risk assessment added to EPIC Grand rounds Risk assessment piloted on paper TSB added to standard order at 24 hrs of age Confidential: For Quality Improvement Purposes Only

5. Grand rounds Resident education done monthly +/- Jaundice added to Discharge note TSB added to standard order at 24 hrs of age Confidential: For Quality Improvement Purposes Only

6. Grand rounds Resident education clarified for discharge instructions Counseling content included in EPIC discharge note Structure developed Sunday TSB for d’ced NBNs TSB added to standard order at 24 hrs of age Care notes content validated added to discharge packets EPIC implementation of risk assessment Confidential: For Quality Improvement Purposes Only

7. Special update: achieved > 90% for first quarter of 2008! Thank you notes from baby with chocolate for compliance Feeding status as part of L&D charge RN report Individual and group education/feedback Lactation Consultant time reallocated to L&D/competency for L&D RNs done Data includes all newborns with mothers desiring to breast feed, no exclusionary criteria applied i.e. maternal illness or transient infant respiratory distress. Confidential: For Quality Improvement Purposes Only

8. Staff reeducation EPIC tools EPIC multidoc pilot implemented Confidential: For Quality Improvement Purposes Only

9. Lactation Consultants enhanced discharge form with community resources Confidential: For Quality Improvement Purposes Only

10. Next Steps Hyperbilirubinemia Breastfeeding • Complete bilirubin risk nomogram implementation into EMR • Assess rate of readmission related to hyperbilirubinemia • Optimize EPIC documentation for breast feeding first latch • Assess percent of breast feeding mothers still breast feeding at 2 month infant visit Contribute to the American Academy of Pediatrics Newborn Care Toolkit which will be developed from this QuIIN. Confidential: For Quality Improvement Purposes Only