The Impact of a Performance Improvement Project on an Important Clinical Outcome: Exclusive Breastfeeding

Sunday, June 15, 2014

Title: The Impact of a Performance Improvement Project on an Important Clinical Outcome: Exclusive Breastfeeding

Tamara W. Eberly, PhD, RN , Office of Continuing Medical Education, University of Virginia, Charlottesville, VA
Lisa Hamlett Akers, MS, RD, IBCLC , Division of Community Nutrition, Virginia Department of Health, Richmond, VA

Discipline: Newborn Care (N)

Learning Objectives:
  1. Define the national public health goals for breastfeeding.
  2. List two traits of performance improvement activities that promote change in practice.
  3. List four evidence-based standards of practice that promote exclusive breastfeeding.
Submission Description:
Objective:

A growing body of evidence demonstrates that performance improvement initiatives increase knowledge, provide resources, and encourage evidence-based improvements in clinical practice. The objective of this study was to determine whether a web-based performance improvement project could improve an important clinical outcome: exclusive breastfeeding.

Design:

This study was an ad hoc data analysis of the “Breastfeeding Friendly Improvement Project: Meeting the Gold Standard in Infant Nutrition”, a Performance Improvement-CME activity designed to improve the promotion and support of breastfeeding.  Participants used a chart audit tool to document exclusive breastfeeding and other explanatory variables that could impact the rate of exclusive breastfeeding.  Describe the 3 phase process. The web-based program using chart data from their individual practice settings allowed participants to proceed at their own pace and to receive individual scores and peer comparisons throughout the process.

Sample:

One hundred sixty-two (162) physicians self-selected to participate in this American Board of Pediatrics approved, MOC Part IV activity.

Methods:

Random effects tobit regression analysis of chart audit data pre- and post-completion of the performance improvement activity were used to determine: clinical practice changes, the improvement in exclusive breastfeeding among patients, and which clinical practices had the best association with increases in exclusive breastfeeding.

Implementation Strategies:

A total of 2587 pre-performance improvement patient profiles and 3240 post-performance improvement profiles were reviewed.

Results:

Improvement in all best practice variables was reported. Following completion of the performance improvement project, exclusive breastfeeding rates in the patient profiles increased 14.50% (p<0.01); Skin-to-Skin Initiation within One Hour of Delivery increased 14.13% (p<0.01); Rooming-In ≥23 Hours increased 13.86% (p<0.01); Breastfeeding Assessment Using an Objective Tool increased 22.58% (p<0.01); and Use of Pacifiers decreased 19.81% (p<0.01).

Conclusion/Implications for nursing practice:

Participation in a web-based performance improvement initiative significantly improved use of evidence-based best practices and rates of exclusive breastfeeding. The role of performance improvement initiatives in providing quality healthcare should not be underestimated and should be embraced by the healthcare community-at-large as an effective tool to improve patient outcomes.  Although the participants in this study were physicians, the activity can be used by other healthcare providers, especially nurses, and would be especially useful in providing aggregate data about a hospital’s practice. 

Keywords:

Exclusive breastfeeding, Breastfeeding rates, Breastfeeding Friendly Hospital Initiative, Pacifier use, Skin-to-Skin, Rooming-in, Breastfeeding assessment tool, and Performance improvement

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.