When Joint Commission indentified "Exclusive breastmilk for all term infants" as a 2010 core measure, the challenge was presented to increase exclusive breastmilk rates in a multi-hospital system using the limited resources of 4 Board Certified Lactation Consultants (IBCLCs).  There is a vast amount of evidence to support that exclusive breastfeeding in the hospital setting leads to increased breastfeeding success rates in the later postpartum period.  Research identifies that the knowledge and training of the bedside nurse is essential in supporting the breastfeeding dyad.

Proposed change:

The 4 IBCLCs collaborated to develop educational tools and training to assist the bedside nurses with providing evidenced-based breastfeeding assistance.

Implementation, outcomes and evaluation:

A baseline competency assessment was completed using an online training module for all bedside nurses in this large healthcare system.  Twenty-five frontline nurses were then given the opportunity to attend an on-site Certified Lactation Counselor (CLC) course.    Each CLC was assigned a mentor IBCLC for guidance and support.  Once the CLC demonstrated competency with the IBCLC, she continued providing staff education and completed competency evaluations for each bedside nurse.  Criteria were developed outlining the roles of the bedside nurse, the CLC, and the IBCLCs.  A triage tool was also developed to identify the breastfeeding dyads at risk and requiring further IBCLC consultation.  An extensive breastfeeding charting tool was created using an electronic documentation system to assist the bedside nurse with documenting breastfeeding intervention and requesting a formal lactation consult.  This documentation system allowed for tracking of exclusive breastfeeding rates and nursing interventions to increase breastfeeding rates.   A lactation chalkboard was developed that centralized this documentation to allow the IBCLCs to identify patients requiring consults.  Also, a central lactation phone line was created for nursing staff and physician office staff to request lactation consults from the IBCLC team.  One IBCLC was selected for the role of Clinical Coordinator of Lactation services, and this role coordinates phone requests and online requests from the electronic documentation system.  Although this project is still in the introductory phase, breastmilk exclusivity rates for the 6-hospital system have increased from 30.1% to 33.7% in one year.

Implications for nursing practice:

This program identifies a multidisciplinary collaborative approach to increasing exclusive breastmilk rates.  The ends results are increasing patient and nurse satisfaction by allowing consistent evidenced-based information to be readily available to all frontline nursing staff thus promoting exclusive breastfeeding.

Keywords: Exclusive Breastfeeding/Breastmilk , hospital, bedside nurse