An Interdisciplinary Approach To Improving Exclusive Breastmilk Rate At Discharge

Sunday, June 15, 2014

Title: An Interdisciplinary Approach To Improving Exclusive Breastmilk Rate At Discharge

Lily Pisegna, MBAH, BSN, RNC-NICN, NE-BC , Women's Services, Sharp Grossmont Hospital, La Mesa, CA
Jeanine Pyka, MSN, RNC-MNN, NE-BC , Sharp Grossmont Hospital, La Mesa, CA

Discipline: Newborn Care (N), Professional Issues (PI)

Learning Objectives:
  1. Identify the 10 steps to becoming Baby Friendly
  2. Identify evidenced-based practices to improve the overall breastfeeding rate at discharge
  3. Identify 1-2 strategies to improving breastmilk supply and breastmilk rate in the NICU
Submission Description:
Objective: To improve the exclusive breastfeeding and breast milk rate at discharge to 71% by the 3rd quarter of 2013.

Design: An interdisciplinary taskforce was created with representatives from the Women and Infants Service Line.  Breastfeeding education was revised to support the 10 Steps to becoming a Baby Friendly Hospital.  Baby Friendly goals and other quality initiatives were adopted by each unit to improve exclusive breastfeeding at discharge.  The Electronic Medical Record (EMR) and interdisciplinary resources were leveraged to identify and support mothers throughout their hospitalization.

Sample: 100% of all well newborns and all premature infants (28-34 weeks gestation).

Methods: Retrospective chart review utilizing computerized software to abstract charts (using The Joint Commission definitions for Perinatal Core Measures).

Implementation Strategies: An interdisciplinary taskforce was formed to standardize and reliably implement evidence-based supportive hospital practices for breastfeeding.  Skin to skin in Labor and Delivey and PACU; EMR identification and interdisciplinary plan of care for newborns having difficulty latching or breastfeeding in postpartum; EMR documentation of 24 hour breastmilk totals,  bedside pumping logs and tracking adequate expressed breast milk (EBM) supply by 2 weeks in NICU. All mothers are encouraged to log and track their breast milk production on the breast pump log throughout their hospitalization. Lactation Consultants develop an interdisciplinary plan of care on all infants having difficulty breastfeeding or requiring specialized care. The plan of care is attached to a specific location within the neonatal EMR.  Lactation Consultants and NICU RNs have daily bed huddles to identify mothers who are having difficulty establishing breastmilk supply.

Results: Based on all the strategies the taskforce implemented, we increased our exclusive breastmilk rate at discharge from a baseline of 49% (July-September 2011) to 71% (April-June 2013). 

Conclusion/Implications for nursing practice: Adopting an interdisciplinary approach involving all key stakeholders throughout the hospitalization is critical to the success of improving exclusive breastmilk rate at discharge.  Implementing evidence-based practice and engaging the staff to take accountability was key to our success.

Keywords: Baby Friendly, exclusive breastmilk, interdisciplinary, exclusive breastfeeding, NICU, breastmilk supply,  Lactation consultants, electronic medical record, bed huddle

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The Association of Women's Health, Obstetric and Neonatal Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.