HOW WE MADE A DIFFERENCE AT WAKE MED CARY

IS WAKE MED CARY UNIQUE?

2010
2533 Births 200 (8%) births <37 weeks gestation 846 inductions 34% 851 C/S 34%

Jan. 2012 Oct.29, 2012

2002 Births 141 7%< 37 weeks 548 inductions 28% 680 C/S 35%

2011
2477 Births 202 (8%) births <37 weeks gestation 700 inductions 29% 787 C/S 33%

WAKE MED CARY AT A GLANCE.

Nine Private Practices 2 practices have midwives Unassigned Patients are seen by one practice Six practices are solo practitioners No NICU. We have a SCN

WHAT WE ALL READY KNEW

Breastfeeding initiation rates were good. Cary has good demographics for breastfeeding. Lactation support is recognized as a satisfier in patient satisfaction surveys.

WHERE DID WE BEGIN?

Management made a commitment to become Breastfeeding Friendly. Hospital invited to participate in PQCNC exclusive human milk feeding initiative. Invited to participate with CGBI initiative to become Breastfeeding Friendly. Breastfeeding committee formed. We meet monthly. 1st meeting was October 14, 2010. Members very enthusiastic! Members joined the group voluntarily.

WHAT WAS ALL READY IN PLACE?

Several local pediatric practices with LCs on staff. We have 2 LCs scheduled 7 days per week. We have a supportive upper management team. Lactation Consultants see all moms intending to breastfeed at least once, usually more. Warm-line One outpatient visit at no charge for mothers who deliver at Wake Med Cary. Loaner pump program for moms discharged before the baby is discharged from Special Care Nursery. Breastfeeding Core Classes for staff.

GOALS
Breastfeeding Committee made a list of goals Committees first goal was to make a change that could be measured. Decided to start with skin to skin. Staff presented with an educational opportunity with multiple choices of when they could attend inservice. It was mandatory! Management supportive of goal.

WHAT DID IT LOOK LIKE WHEN WE STARTED?

Breastfeeding initiation rate 90% Exclusive breastfeeding rate 49% Pacifier use was 40% Skin to skin for vaginal births 70%. C/S 7% Moms demonstrated hand expression 6% Moms informed of breastfeeding support in the community 49%

BARRIERS
Some staff resistant to change. Inconsistent information given to moms from MD and some staff. Negative comments. Formula reps very ingrained in the culture at Wake Med Cary (Lots of free lunches) Open door policy for formula reps. Cost of purchasing formula Lack of education. Staff worried that patient satisfaction would decrease. Consistency/ Buy in from staff

EDUCATION
All staff required to complete required amount of breastfeeding training as outlined in the NCBFMCD. Two day long breastfeeding core classes every year. Educations cover all of the ten steps. Updated every 2 years. Staff required and paid to attend. Staff receive CEUs. Staff required to shadow and LC for 5 hours . LCs available 7 days per week . Deadlines for completing training and shadowing were posted and discussed with staff at staff meetings and in staff updates. Unit educator kept track of employees education and shadowing hours. All staff were required to complete the University of Virginia training on line. www.breastfeedingtraining. org

POLICY
Breastfeeding policy was written by hospital wide Breastfeeding Friendly committee. Took several months to write.. Policy approved and made effective May 2011 Staff were all required to read policy. All staff had to sign a document stating that they had read and understood the policy.

PACIFIERS / SUPPLEMENTATION/ THE BAGS

Many staff members did not understand how we could manage without pacifiers. A handout was created to script what the nurse should say to a parent who requested a pacifier. Staff have been educated on appropriate supplementation at the core classes. Formula gift bags discontinued Mothers Day 2011. many staff feared patient satisfaction rates would go down. Reality: Very few complaints. Quite a few compliments from patients who applauded the hospital for making the effort to becoming breastfeeding friendly

HOW DID WE MEASURE?

One person designated as data entry. All dyads included in data collection that met PQCNC guidelines. Not just a percentage of dyads. Printed on bright yellow paper Audits done on data collection forms

HOW DID WE GET STAFF ON BOARD

We gave them the tools they needed to be successful. We provided them with education. We listened to complaints, concerns and we reassured them. We gave them lots of positive feedback. Management restated the goals consistently. Some staff continued to complain. We listened an restated the goal of reaching 5 stars We praised and we praised and we listened and listened. And we did not waiver. And we gave them the GOOD results. AND WE WILL NOT WAIVER

SUPPORT GROUP
Started in Feb. 2012 1st meeting 3 moms and babies Most recently 20-23 WOW!

WHERE ARE WE NOW.

Steps 1,3,5,8,9 and 10 completed We are working on: Physician training. Skin to Skin after C/S birth Free formula Rooming in 22 hours or more We continue to offer Breastfeeding Core Classes. The classes are separated into basic class and advanced class. We have a bi-annual blitz for the nursing staff. Competency based.

STATS NOW
Exclusive breastfeeding rates are 68% Initiation rate of 90-95% Pacifiers no longer provided by staff except for painful procedures. Teaching hand expression is 90% Skin to Skin after delivery 67% . Dependent upon mode of delivery Breastfeeding support 91% Baths are routinely delayed until baby has had a feeding.

AND WE HAVE.. 3 STARS!!!!!!!!