Lactation Management & Multidisciplinary Breastfeeding Quality Improvement DATE

1. On the Road to Baby Friendly Lactation Management & Multidisciplinary Breastfeeding Quality Improvement DATE A BBC document developed by Region 8 RPPC with Title V funding through CDPH/MCAH, 2010.

2. Goal: Clarify role of lactation management and multidisciplinary QI in pursuit of Baby Friendly designation Data collection Out pt f/u NICU Staff continuing ed Well baby Baby Friendly Use of donor milk CLE staff ed Staff competencies MD education Work place lactation

3. Objectives: The learner will be able to • Examine statistical parameters of current Hospital’s perinatal practice and their implications for lactation management (i.e. Are we going up or down & why?)

4. Objective: • Discuss the findings of Hospital’s staff needs assessment (i.e.What do we know? What do we need to know?)

5. Objective: • Relate the Plan, Do, Check, Act cycle to Hospital’s quest for Baby Friendly designation (i.e. What have we done? What do we still need to do? )

6. Objective: • Identify the role of multidisciplinary QI (MQI) in the further pursuit of Baby Friendly designation (i.e. How can we ALL work together to make it happen? )

7. Statistical Snap Shot of Your HospitalPerinatal Profile Data

8. Symbol Key • ▲▼= high or low rates relative to state • ↑↓ = dynamic changes relative to your past performance or population • ~ = stable rates relative to your past performance

9. Hospital Demographics • Live Births = 2,520 ⃗ 2,401 ⃗ 2,103↓ • White = 51.0% ⃗ 44.1% (▲) ↓ • Hispanic = 32.3% ⃗ 37.1% ↑ • Black = 5% ⃗ 3.2% ↓ • Asian/Pac Islander = 14.9% ⃗ 16.9% ↑ • Other = 0.2% ~ • Foreign Born = 26.4% ⃗ 25.8% (▼) ↓

10. Perinatal Characteristics • Low Birth Weight = 5.7%⃗ 6.1%↑6.5% • VLBW, MediCal (▼), Moms <18 (▼) =↓ • Multiples (▲) = 3.9% ⃗ 4.6% ↑15% • Mothers (▲) >34 = 22% ⃗ 22.1% ~ • Incomplete high schl (▼) =10.1% ⃗4.3%↓

11. Prenatal Care • First trimester (▲) = 95.5% ⃗ 96.6% ↑ • Third trimester (▼) = 0.5% ⃗ 0.4% ↓sl • No prenatal care = 0.3% ⃗ 0.2% ↓sl • Unknown care = 0.1% ~ Hospital + prenatal patients = Rank in the county?

12. Cesarean Sections (’02- Present) • Primary = 17.4% ⃗ 19.3% ↑ ’02-’08 • Repeat = 10.3% ⃗ 13.5% ↑ ’02-‘08 • Current rates: 33% • Primary = 18-20%

13. Hospital Death Cohort Data

14. Birth/Death Cohort Ratios • Fetal Mortality (≥ 500 grams) • Indicator: Prenatal & Perinatal Care • Standardized Ratio = 0.82 • Neonatal Mortality (Birth to 28 days) • Indicator: In-hospital care • Standardized Ratio = 0.78 • Post Neonatal Mortality (29 days - 1 yr) • Indicator: Access to/quality of community care • Standardized Ratio = 0.61

15. Birth Certificate Missingness • Why do we care? • Hospital 2005-2006 = < 2% • What’s missing?

16. Birth Certificate Missingness -2005 Gestational Age Maternal Ed in years

17. Birth Certificate Missingness -2006 Gestational Age Maternal Ed in years

18. Hospital Patient –Staff Partnership

19. Zeroing in on Breastfeeding

20. Hospital Lactation Management Ex BF Rates ↑ <1% annually prior to Soft/BBC Rates ↑ 2.5% (average) annually after

21. Breastfeeding Data Implications • Current EX BF rate = 58% • Questions from the data • Is 58% accurate – are all pts counted by whom, using ? Tool • Ask the staff!!

22. Hospital Needs Assessment

23. Hospital Needs Assessment Summary

24. Implications of Needs Assess. Findings • 20 respondants – all depts represented? • All comfortable w/Soft-BBC information • All comfortable w/using the information • Risk/referral questions (#7,8) a little scatter • ?Recognizing risks • ?Referral resources • ?Staff role delineation • Multidisciplinary QI Team-how is MQI change communicated? • 25% aware of a MQI Team (#10) • 50% either no input or input not used (#11, 12, 13) • 25% see no change after MQI (14)

25. Implications of Needs Assessment Findings

26. Possible MQI Activities (from needs assessment) • Data accuracy • Some staff need help with • Recognizing risks • Referral resources (in-pt, out-pt?) • Staff role delineation (RN vs CLE vs CLC vs IBCLC)

28. QI Issues • Clarification of data collection – accuracy • Tools • Sources of data • Collection period of time

29. Evaluation of Outcome Data • Crosscheck data sources – do they agree

30. Tools of the Trade

32. Implementation of Policy Review/Revision for Data Collection • Share hard data w/MQI Committee • Explore role of MQI Committee • Follow process for policy/procedure changes • Clarify responsibilities • Communicate

33. Other MQI Activities (from needs assessment) • Some staff need help with • Recognizing risks • Referral resources (in-pt, out-pt?) • Staff role delineation (RN vs CLE vs CLC vs IBCLC)

35. MQI • Breaks down the silos of health care in and out of the hospital Administration Risk Management L&D MDs Mother Baby Lactation NICU Out Pt In Patient Nursery

36. Wrap Up • The evidence says. . . . • to your perinatal staff and service • To achieve and maintain Baby Friendly, everyone has to jump on board

37. MQI smooths the bumps in the road, creating partnerships

38. Our most important partners. . . • Thanks for the good work you do!!