Implementing a New Nurse-Sensitive Quality Metric: Initiation of Breastfeeding within 60 Minutes of Birth

Purpose for the program:

The purpose of this presentation is to propose a feasible nurse-sensitive quality metric, ‘Initiation of Breastfeeding within 60 Minutes of Birth,’ along with a toolkit for implementation.  

Proposed change:

Develop and define quality measures sensitive to obstetric nursing care that can be replicated across institutions. 

Implementation, outcomes and evaluation:

A team of 7 Magnet-accredited hospitals collaborated to define the elements of quality obstetric nursing care.  The team included perinatal nurses, nurse managers, informaticists, and report writers.  A pilot project was then established by The Christ Hospital and Summa Health System for the first proposed metric, ‘Initiation of Breastfeeding within 60 Minutes of Birth.’  Development of documentation and reporting tools followed.  Priorities for development included: evidence-based, simple and uniform documentation, efficient data collection methods, and reporting tools to track and drive improvements in quality of care. The documentation tool specifies exclusions to breastfeed then a single question, “Breastfeeding” with cascading documentation options based upon the staff entry of “yes” or “no.”  Staff input was imperative so that the documentation integrated with normal workflow and allowed real-time access at the point of care.  Standardized reporting tools were then developed for enterprise and departmental information systems as well as paper-based records. 

Pilot work has resulted in the development of a toolkit for the proposed quality metric, ‘Initiation of Breastfeeding within 60 Minutes of Birth’ and includes documentation and reporting tools, staff education modules, and result dissemination materials.  Pilot hospitals have met monthly to evaluate effectiveness of the toolkit’s implementation and replicability.  Pilot hospitals have been tracking nurse compliance with the metric ‘Initiation of Breastfeeding within 60 Minutes of Birth.’  Rates of ‘Initiation of Breastfeeding within 60 Minutes of Birth’ based on standardized numerators and denominators are also being evaluated to establish short-term and long-term benchmark goals for quality improvement.  Next steps for this project involve creating a data-sharing database and extending pilot work to include the two other quality measures proposed by the team of Magnet-accredited hospitals. 

Implications for nursing practice:

Labor and delivery nurses have a critical role to ensure women initiate breastfeeding within 60 minutes of birth.  Implementation of a toolkit to track and improve the initiation of breastfeeding has the potential to increase national breastfeeding success rates and maternal and neonatal outcomes.  Improving rates of the initiation of breastfeeding can also positively affect the established national metric of Exclusive Breastfeeding. 

Keywords: metrics, toolkit, and data collection