Sustaining Baby Friendly Excellence with Innovative Strategies

Purpose for the program: The journey to obtain Baby Friendly began in 2009 with the culmination of designation in 2011. It was recognized that nursing practices could be challenged and improved beyond the Ten Steps. The traditional methods of education were becoming fiscally demanding and lacked a measurement of effectiveness.

A review of the literature provided examples of practices that had been associated with improved exclusive breastfeeding rates. The literature did not provide us with a fiscally responsible and effective mechanism to educate. The measurement of success chosen to evaluate the proposed changes was the Joint Commission (TJC) Perinatal Core Measure (PC-05) and the quality improvement process provided by Baby Friendly.

Proposed change: The shared governance council reviewed the literature and voted to concentrate on two practice changes: immediate, uninterrupted skin to skin after vaginal birth and delaying the bath for a minimum of 12 hours.

The leadership also determined that education needed to be engaging. After evaluating options, a game show question and answer session was created that was easily completed at staff meetings.

Implementation, outcomes and evaluation: A gap analysis was conducted with stakeholders to determine barriers to the proposed practice changes. Some barriers identified were: the need to document birth weight immediately after birth, nursing assessments, and administering medications being done at the warmer, bathing done based on a nursing checklist and a lack of patient  knowledge. A variety of strategies were utilized to address each barrier. Pre-implementation the exclusive breastfeeding rate was 64%. The rate has steadily increased to 90% as compared to 78% which was top 10% in TJC core measure hospitals in 2013.

The second initiative of educating staff was implemented with the Baby Friendly QI process. Staff was provided education in a non-traditional game show fashion. Staff was then individually interviewed. The interview tool evaluated the staff knowledge of the Ten Steps as well as how the hospital integrated them into practice. A total of 80% of the staff were interviewed. 100% of the interviewees were able to articulate appropriate answers to the entire tool. Patient rounding by leadership also corroborated the results- patients were receiving consistent messaging about breastfeeding.

Implications for nursing practice: Evaluating typical nursing practices may reveal opportunities to change work flow and processes to improve exclusive breastfeeding rates. Education can be completed utilizing a less traditional modality and can be effective.  

Keywords: PC 05, Baby Friendly, Breastfeeding