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Sunday, June 24, 2012

Title: Increasing Exclusive Breast Milk Feeding Rates At An Urban Academic Hospital

Woodrow Wilson (Gaylord National Harbor)
Laurie Dohnalek, RN, MBA, NE-BC , Perinatal Services, Georgetown University Hospital, Washington, DC
Cynthia Heer, RNC-OB, RN-BC, MSN , Perinatal Services, Georgetown University Hospital, Washington, DC
Lauren O. Wurster, RN, MSN , Perinatal Services, Georgetown University Hospital, Washington, DC
Carol A. Ryan, MSN, RN, IBCLC, FILCA , Perinatal Services, Georgetown University Hospital, Washington, DC
Elizabeth Starrels, RN, BSN, IBCLC , Perinatal Services, Georgetown University Hospital, Washington, DC
Margaret Howland, RN, BSN, RNCOB , Nursing, Georgetown University Hospital, Washington, DC, DC

Discipline: Newborn Care (N)

Learning Objectives:
  1. Describe three interventions that increased the exclusive breast milk feeding rates
  2. Explain how the program improved the knowledge and skill set of the staff
  3. Discuss why exclusive breast milk feeding is important for newborns
Submission Description:
Purpose for the program:  The purpose of the program is to increase exclusive breast milk feeding rates at an urban academic hospital.

Proposed change:  Over an 18 month period interventions were implemented to increase exclusive breast milk feeding rates by at least 10%.

Implementation, outcomes and evaluation:  To implement this program, the following interventions were completed:

  • Creation and implementation of Donor Pasteurized Milk Policy - all nurses attended mandatory education session
  • Implementation of 24-hour rooming in (no separation of mothers and newborns via standard nursery)
  • Survey given to patients to identify the most popular reasons for supplementation
  • Journal Clubs discussing breastfeeding issues
  • Consultations with Lactation Consultants at other facilities
  • Increasing rates and duration of initial skin to skin contact and first breastfeeding session
  • Daily patient rounds and assessments by International
    Board Certified Lactation Consultant (IBCLC) 
  • Mandatory interdisciplinary breastfeeding education for all nurses, obstetricians and pediatricians
  • Education related to alternative breast milk feeding methods
  • Outside speaker (IBCLC) that moderated discussion of obstacles to exclusive breast milk feeding
  • Feeding Care Plans (for complicated situations) developed collaboratively with nurses and IBCLCs
  • Implementation of mother and newborn “Quiet Time”

Outcomes: These interventions were implemented and the result was an increase in the staff’s knowledge and skills thus changing practice and creating confidence.  The outcome was that our exclusive breast milk feeding rates increased.

Evaluation: A data collection tool was created to monitor/track exclusive breast milk feeding rates.  We are also utilizing a patient based survey to evaluate the effectiveness of the interventions.

Implications for nursing practice: Education is a major aspect of our initiative to increase exclusive breast milk feeding rates. The low incidence of exclusive breastfeeding is partially due to a lack of breastfeeding knowledge among health care professionals. Educational programs that increase nurses’ knowledge and improve attitudes towards breastfeeding promote accurate and reliable delivery of breastfeeding information and skills to the mothers. These programs also encourage positive role modeling of supportive breastfeeding attitudes. This may improve exclusive breast milk feeding rates due to the effect that this has on patients. Many of the interventions included in our program are directly aimed at increasing breastfeeding knowledge for our staff and patients.

Keywords:  Exclusive breastfeeding, Exclusive breast milk feeding, Breastfeeding rates, Joint Commission, Perinatal Core Measure

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