Teams are hard at work collecting data and planning and implementing changes in their units with the goal of increasing the use of exclusive human milk...
PQCNC has been asked by the March of Dimes (MOD) if the PQCNC EHM groups would be willing to include a new MOD program in the effort to increase exclusive human milk rates in NICUs and nurseries. The MOD module called "Close To Me" is designed to promote and support kangaroo care. The initial version of this module is designed with NICU infants in mind but MOD would like to modify this module for use in promoting skin to skin care in all newborns. There are presentations geared to families and providers. In addition to supplying us with the actual powerpoints, March of Dimes is willing to donate fliers and Close To Me Buttons to promote skin to skin efforts.
There was significant interest expressed by all centers attending the initial webinar in participating in developing a Nursery version of Close to Me. The meeting closed with a general agreement that the EHM Nursery Collaborative would identify a small working group interested in collaborating with MOD to create such a product.
The Working Group has convened and work is underway. Key thoughts the team is considering as they adapt the components:
• There needs to be an increased focus on the connection between S2S and breastfeeding – evidenced through pictures and research
• Content material needs to include the immediate post-partum S2S opportunities for dad
• The emphasis is on breast feeding, but not to exclude or alienate the bottle feeding parent
Once it is developed the larger PQCNC EHM Nursery Collaborative offers multiple unique laboratories in which to determine how Close To Me might be incorporated into couplet and well nursery care.
Teams are hard at work implementing change and piloting creative approaches. A particular area of emphasis has been on skin-to-skin care. According to some NICU parents, the first time they considered themselves real parents was the first time a nurse encouraged them to hold their baby skin-to-skin. Kangaroo care enables moms to regain the temporarily lost relationship with their child, and enables fathers to experience the beginning of a new relationship. Most importantly for our initiative, studies have found that mothers increased their milk volume, doubled rates of successful breastfeeding and increased duration of breastfeeding with skin-to-skin holding. A small team, drawn from the Human Milk Well Baby Initiative is exploring partnering with the March of Dimes to adapt "Close to Me" - a comprehensive set of awareness and educational activities, tools and products designed to increase the onset and frequency of Kangaroo Care in the NICU - to the nursery setting.
20 NC hospitals who have been working together to increase by 50% the number of babies discharged exclusively breastfeeding in North Carolina Maternity Care Centers attended Learning Session 2 to share successes and challenges, hear from parent’s whose breastfed their infants, and, support each team to continue to work on this important aim. During the course of the day there were presentations on working from the front line perspective, incorporating the parent perspective in quality improvement work, eliminating supplementation, and ample time for teams to share tools and techniques.
Teams are hard at work implementing change and piloting creative approaches. The featured example for this month: While feeding guidelines are recognized as an important tool in caring for very low birth weight infants, one of the teams in the initiative is piloting an infant feeding plan document with mothers of well term newborns. The aim of the document is to give a mother important information about how the staff will be supporting her in her choice, as well as create a visible indication to all providers of a mother’s intentions. Several teams in the initiative have identified that despite a mother’s indication that she will be breastfeeding her infant, staff often unwittingly provide barriers or fail to support frequent feedings and skin to skin time. This novel approach of providing anticipatory guidance (a standard practice in most settings) with a written plan signed by the mother and attached to the infant’s bassinet has the potential to increase the number of times the staff actions are in concert with the mother’s feeding choice.
Almost every action of this initiative can be summarized as keep the mom and baby together during the maternity stay and help moms increase nursing frequency! Keeping the mom and baby together and assuring uninterrupted time for rest and frequent nursing is no simple issue in hospitals today. Teams are testing how to create “nap time” or quiet time on the unit and how to convey this to visitors and staff. Staff are increasingly able to answer BF questions and assess BF because every team has continued to focus on staff education. Lactation consultants have taken the lead in many centers to provide this education and mentoring. A few teams have tested how to teach hand expression and one reports there is no better answer to the worried mom who believes she has no milk than teaching her hand expression.
A webinar learning session was held in late February and 20 of the 26 teams were able to sign on to a virtual classroom website. Centers are testing a variety of small changes including the best way to ascertain mom’s intention to provide milk for her baby, how to increase skin to skin in both the delivery room and the post-partum floor and how to decrease the time mothers and babies are not together. Additionally, several centers have instituted new classes for staff, opportunities for staff to shadow lactation consultants, created posters and surveyed staff regarding knowledge and attitudes. The next webinar is scheduled in late March.
Where: McKimmon Center, 1101 Gorman St, Raleigh, NC 27606
When: Tuesday, May 3, 2011 9:00 - 3:30
What: All three primary team members (physician champion, nurse champion, senior hospital administrator) are encouraged to attend. Teams are also encouraged to bring up to six team members to the learning session, such as quality/performance improvement personnel, staff nurses, patient advocates, educators and others. CME Category I credit, lunch and materials will be provided at no cost.
How: Registration is closed - please use the "Contact us" link above if you have questions
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