Guidelines support exclusive breast milk feeding (EBMF) starting within the first hour of life. This goal ignited passion for change at this 550 bed community teaching hospital with 3200 births/year, fueling ideas to meet The Joint Commission's standards and to provide patients with evidenced based practice, while increasing our rate of EBMF.

Proposed change:

A multifaceted, multidisciplinary approach to change the culture of the entire family care service focused on medical and nursing staff interventions, processes for care, environmental changes, and maternal education. We started with an EBMF rate of 32% and a goal of 50%. Our initiation rate was 79% proving patient interest but illustrating the need for changes targeted at sustaining EBMF.

Implementation, outcomes and evaluation:

Pediatricians were included in education and signed a contract agreeing to support EBMF. Lactation consultants (LC) worked with pediatricians regarding discharge planning and with obstetricians for management of mastitis, engorgement, inadequate supply and pain. Nurses and LCs formed a BF committee to discuss concerns and roadblocks. They developed consents for mothers to sign for formula supplementation and encourage mothers to provide expressed BM instead of formula. To expand LC services, all carried phones with coverage daily and inclusive of all shifts. Staff and mothers were dissuaded from providing pacifiers except during painful procedures. LC triage practice was developed starting in L&D to follow high risk infants from birth to discharge. L&D nurses started routine breastfeeding education on admission, and now provide EBM to infants unable to breastfeed. Staff was updated on EBMF rates routinely. Readmission rates of newborns fell after implementation of strategies. Nursing orientation in all OB areas now includes 8 hours with LC. We stopped providing formula gift bags to EBMF patients. An outpatient lactation clinic was opened to assist with follow up care. This clinic is open daily inclusive of weekends and holidays, to ensure that feeding, infant and maternal assessments can be readily accomplished. The clinic is open to the community, renting breast pumps and selling breastfeeding supplies. Education and support increased and continues for staff, physicians and the community. Deviation from policy is not tolerated by nursing or medical directors. Our current initiation rate is 83% and EBMF rate is 68%.

Implications for nursing practice:

Multiple factors fueled the fire and increased passion for change. While many were reluctant to embrace this change, the passionate nurses involved sparked the fire for improvement.

Keywords: Exclusive breastmilk feeding, lactation