Improving Hospital Breastfeeding Support Leveraging Kaiser - PowerPoint PPT Presentation

Improving Hospital Breastfeeding Support Leveraging Kaiser Permanente’s Implementation Toolkit Jocelyn Audelo, RN MPH, Senior Consultant, Kaiser Permanente Care Management Institute

Our Numbers • 17,000 physicians Total Membership: 9.1 Million • 176,000 employees (more than 49,000 nurses) • 88,000 births (72,000 in California) – 2013 Northwest Region Portland, OR  Vancouver, WA  Colorado Region 484,349 members  Denver / Boulder, CO  Colorado Springs, CO Northern  Mid-Atlantic Region Pueblo, CO  California Region 546,065 members  Washington, DC   3,430,528 members Maryland  Virginia  485,086 members  Southern California Region  3,645,322 members Georgia Region Atlanta, GA  239,124 members  Hawaii Region 224,683 members  2

3

Kaiser Permanente Hospital Breastfeeding Toolkit  Launched in April 2013  Commitment with Partnership for a Healthier America (PHA)  3,300+ unique page views in first 4 months 4

Essential Components 5

Performance Improvement What is the best way to approach making a change that results in improvement?  Thinking about doing something better is often easy  Actually making a change is not 6

Five Central Principles of Improvement 1. The aim or goal of the project is clear 2. Regular performance data drives the work 3. Changes are designed to improve the current process 4. Changes are tested before implementing 5. Teams consisting of people doing the work are key 7

Kaiser Permanente Northern California Model 8

The Charter is the Roadmap AIM – What are we trying to accomplish? Improve rate of exclusive breast milk feeding to [percent] by [date] at the facility GOAL – How will we accomplish our aim? Standardize and reliably implement evidence-based practices for mothers who choose to breastfeed 1. Skin-to-skin contact 2. Early breastfeeding within one hour 3. Consistent breastfeeding education and assistance 4. Supplementation with formula limited to medical indications MEASURES – How will we know if we have improved? 1. Skin-to-skin contact 2. Early breastfeeding 3. Exclusive breast milk feeding without supplementation 9

Breastfeeding Collaborative Timeline Months 2-3 Month 4 Months 5-6 Month 8+ Month 1 Month 7  Subject Matter  Regional charter  Site teams  Continue testing  Leaders agree to  Host learning  Continue Expert meeting established sponsor initiative session collaborative calls  Identify sites  Host expert for the year  Review evidence  Assess current meetings: review  Continue to collect  Spread best  Build local teams practice work to date  Planning meeting data and identify practices across all  Identify goals with steering group • MD leader best practices sites  Design baseline  Pilot sites develop  Identify measures data measurement materials for • RN leaders sharing with other  PDSA Cycles begin • Quality advisor sites at learning session Sites testing •  Kickoff changes and collaborative call collecting data  Begin monthly collaborative calls across sites Structure Process Outcomes Subject matter expert team Charter, measurement strategy    Learning  Site teams / front line staff  PDSA testing tools Spread   Support: Collaborative calls  Action periods  Improvement Change package / toolkit   Improved outcomes

Using data to drive performance Project Measures (Sample) Documented Skin-to-Skin Contact within Timeframe 100% 90% 80% 80% 70% 65% 70% 62% 60% 60% 50% 40% 40% 30% 20% 10% 0% Target Documented Skin to Skin Contact within Timeframe 11

Kaiser Permanente Breastfeeding Toolkit www.kpcmi.org 12

Appendix

The Breastfeeding Collaborative PI Model Based on the Institute for Healthcare Improvement Model for Improvement What are we trying to accomplish? Asks three How will we know that a questions change is an improvement? What change can we make that Changes That will result in improvement? Result in A P A P Improvement S D S D DATA D S D S Implementation P A P A Act Plan of Change A P A P S D S D Wide-Scale Tests of Change A P A P Study Do S D S D Follow-up Tests Model for Improvement developed by Very Small Associates in Process Improvement Scale Test ( http://www.apiweb.org) PDSA 14

Sample PDSA Timeline Skin-to-skin (STS) contact and exclusive breastfeeding Staff use standard Act Plan • script when documenting in EMR. Create check list and roll • Adopt checklist and • out communication Study Do job aid if results during weekly huddles Communicate Job Aid by • reflect success. and place on charts. posting on computers and introducing at huddles. Evaluate results of • • Create a • Refined process and roles 20 sample cases. comprehensive, and responsibilities. easy-to-read EMR • Present information documentation job and following up at aid for staff to use. • Process flow developed weekly huddles. and tested by staff. Post run charts in • Confirm that items to break room. be documented have Determine identified locations in • Standardize process and • communication and EMR, and who has confirm roles and education process. responsibility. responsibilities. 1. Develop a way to ensure 2. Confirm process flow 3. Review to determine staff document STS and create checklist tool whether tests are creating a consistently in EMR sustainable process

Skin-to-skin RN Checklist Vaginal Delivery Task  Educate mother about benefits of skin-to-skin Before birth  Raise or remove gown  Deliver infant to mother on bare abdomen or chest  Dry infant (not hands) on mother’s abdomen First 10 minutes  Bring naked infant to mother’s bare chest (if not already there) after baby is born  Cover mother and infant with warm blanket  Take first newborn vital signs  If infant brought to ALS, bring back, unwrap, and place skin-to- skin on mother’s bare chest 10-30 minutes  Offer assistance with latch after baby is born  Document uninterrupted skin-to-skin in EHR  Document breastfeeding status/attempts  Provide newborn medication, give bath, and 2 nd vital signs 1-2 hours  Transfer to Mom-Baby unit while skin-to-skin after baby is born  Document additional skin-to-skin and breastfeeding

Process map: Skin-to-skin (STS) after C-Section • Pre-op teaching on benefits of skin-to-skin Pre-op contact • Incorporate skin-to- skin plan in OR “time out” Delivery Baby is born Is mom or baby compromised? YES NO Pedi MD takes baby to warmer Manage per protocol Pedi MD / Transition RN • Assigns 1-min and 5-min APGAR Anesthesia • Prepares mom’s arms to accept baby, as needed Transition RN Postpone bath until • Unbuttons mom’s gown after at least 1 hour • Makes room to assist with STS of skin-to-skin Transition RN • Places naked baby across mom’s chest, baby’s face toward RN for monitoring • Covers baby’s back with warm blankets (use warming therapy unit as needed) • Encourage breastfeeding • Initiate documentation in EHR Transition RN • While mom prepares to move to gurney, RN takes Mom and baby transferred together, baby for vital signs, weight, and measurement to continue skin-to-skin / breastfeeding in recovery unit Labor & Delivery RN • Assists mom to gurney for transfer to recovery unit