Transforming the Care Delivery Model for mothers and babies began in 2010 with an invitation to participate in the New York State (NYS) Breastfeeding Quality Improvement in Hospitals Learning Collaborative.  Twelve hospitals were selected to participate with the following objectives: increase exclusive breastfeeding; improve hospital breastfeeding policies, practices and systems that are consistent with NYS hospital regulations, laws and recommended best practices; increase staff skills and knowledge of breastfeeding and lactation support through education; empower, educate and support new mothers to successfully breastfeed and change the culture and social norm relative to breastfeeding. 

Proposed change:

To fully transform maternity practices within a NYS Regional Perinatal Center to comply with and support the recommendations for exclusive breastfeeding outlined by the World Health Organization (WHO) by changing the Care Delivery Model. 

Implementation, outcomes and evaluation:

The journey to transform the Care Delivery Model supporting exclusive breastfeeding began in June, 2010.  The hospital formed a comprehensive team to evaluate current processes and potential barriers that inhibit exclusive breastfeeding.  Team members were selected based on knowledge of the hospital systems and commitment to change.  Priority was given to changes that could be accomplished quickly and sustained.  The initial change focused on placing all newborns skin-to-skin in the delivery room, successfully latching and breastfeeding within one hour for vaginal deliveries and two hours for cesarean deliveries.  To increase rooming-in on the postpartum unit, newborns were brought back to the nursery only upon request by the mother.  Physician order sets were revised to distinguish orders for formula fed and breastfed infants to discourage supplementation of breastfed infants. The most dramatic change in practice implementing the Care Delivery Model involved closing the transitional nursery and providing transition care in Labor and Delivery by the nursery RNs eliminating the separation of mother and infant. The Model for Improvement utilized Plan-Do-Study-Act cycles to test each change in the work environment and revise accordingly.  Critical to the success of this program was the active participation of direct care nursing staff evaluating their practice with each change and providing feedback.  Since inception, exclusive breastfeeding increased from 6% to 34%, rooming-in increased from 0 to 50% and skin-to-skin increased from 50% to 80%.  Transition care is relocated to the Delivery Room and the newborn nursery is utilized for respite care. 

Implications for nursing practice:

Change the Care Delivery Model for mothers and babies to support exclusive breastfeeding as recommended by the WHO through education, training and process improvement.

Keywords:

Exclusive Breastfeeding

Transforming Care

Process Improvement