4/14/2016 Karen Peters Disclosures 2 • No financial disclosures Joint Commission’s • Represents BreastfeedLA Perinatal Care Core Measure • Does NOT represent – Baby-Friendly USA Exclusive breast milk feeding – The Joint Commission 9/18/13 April 14, 2016 1 Beginning January 1 st , 2014… Perinatal Care Core Measure Set 3 4 • PC-01 Elective delivery ALL hospitals with 1,100 or more deliveries will • PC-02 Cesarean section be required to submit the Perinatal Care (PC) Core • PC-03 Antenatal steroids Measure Set to The Joint Commission for accreditation accreditation • PC-04 PC 04 Health care–associated Health care associated bloodstream infections in newborns • PC-05 Exclusive breast milk feeding • PC-05a Exclusive breast milk feeding considering mother’s choice April 14, 2016 3 April 14, 2016 4 1
4/14/2016 Perinatal Care Core Measure Set Defining Exclusive Breast Milk Feeding 5 6 • PC-01 Elective delivery “A newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting • PC-02 Cesarean section of vitamins, minerals, or medicines. • PC-03 Antenatal steroids Breast milk feeding includes expressed mother’s milk as • PC-04 PC 04 Health care–associated Health care associated well as donor human milk, both of which may be fed bloodstream infections in to the infant by means other than suckling at the newborns breast. While breastfeeding is the goal for optimal • PC-05 Exclusive breast milk feeding health, it is recognized that human milk provided • PC-05a Exclusive breast milk feeding indirectly is still superior to alternatives.” considering mother’s choice April 14, 2016 5 April 14, 2016 6 PC-05 Exclusive Breast Milk Feeding Newborn Exclusions Numerator & Denominator 7 8 # of term singleton newborns The measure will exclude from the denominator the following infants: that were fed only breast milk since birth – NICU – Galactosemia Galactosemia # term singleton newborns discharged from the – TPN Infusion hospital (of non-excluded categories) – Experienced death – Length of Stay >120 days – Enrolled in clinical trials April 14, 2016 7 April 14, 2016 8 2
4/14/2016 NICU Desired Outcome 9 10 Questions about admission to the NICU • The Joint Commission wants to see an increase in the rate of exclusive breastfeeding over time. • There must be complex medical reasons • Critical care services were provided • Does not include an observational nursery April 14, 2016 9 April 14, 2016 10 Documented Reason for Not Exclusively Documenting Maternal Reasons Feeding Breast Milk 11 12 The Joint Commission describes the only acceptable maternal reasons for Reasons for not exclusively feeding breast milk which “breast milk feeding should be avoided” as: during the entire hospitalization are clearly HIV infection • documented in the medical record. Human t-lymphotrophic virus type I or II • Substance abuse and/or alcohol abuse Substance abuse and/or alcohol abuse These reasons are due to a maternal medical These reasons are due to a maternal medical • Active, untreated tuberculosis • condition for which feeding breast milk should be Taking certain medications, i.e., prescribed cancer chemotherapy, • radioactive isotopes, antimetabolites, antiretroviral medications, and other avoided or due to mother’s choice to not breast medications where the risk of morbidity outweighs the benefits of breast milk feeding feed upon admission. Undergoing radiation therapy • Active, untreated varicella • Active herpes simplex virus with breast lesions • April 14, 2016 11 April 14, 2016 12 3
4/14/2016 New Wording for 2013 Perinatal Care Core Measure Set 13 14 • There is documentation that the newborn’s mother • PC-01 Elective delivery chose not to breast feed upon admission. • PC-02 Cesarean section • PC-03 Antenatal steroids • A mother’s choice to not breast feed upon admission • PC-04 PC 04 Health care associated Health care–associated must be clearly documented in the newborn’s medical must be clearly documented in the newborn s medical bloodstream infections in record in the context of the newborn feeding method newborns in order to select allowable value “2”. Do not assume that the newborn was not exclusively fed breast milk • PC-05 Exclusive breast milk feeding due to maternal choice in the absence of such • PC-05a Exclusive breast milk feeding documentation. considering mother’s choice April 14, 2016 13 April 14, 2016 14 PC-05a Exclusive Breast Milk Feeding Considering Examples Mother’s Choice – Numerator & Denominator 15 16 # of term singleton newborns Healthy term infant who gets that were fed only breast milk since birth dehydrated from poor milk transfer = not excluded # of term singleton newborns discharged from the hospital excluding those whose mothers chose not Healthy term infant gets supplemented with to breast feed at admission expressed milk or donor milk = counts as exclusively breast milk fed April 14, 2016 15 April 14, 2016 16 4
4/14/2016 Hospital Example for PC-05 Hospital Example for PC-05 17 18 Hospital example Of 150 in denominator: 200 births total: 50 moms don’t want to breastfeed at all 20 wanted to breastfeed but later got formula at 20 born to substance abuse mothers mother’s request q 5 born to HIV+ mothers 5 born to HIV+ mothers 10 get formula for medical reason (e.g., dehydration and 10 born before 37 weeks other reasons not found on exclusion list) 10 who are multiples 5 spent time in NICU Numerator = 70 Denominator =150 April 14, 2016 17 April 14, 2016 18 Hospital Example for PC-05 Hospital Example for PC-05a 19 20 Hospital example Percentage of infants exclusively breastfed: 200 births total: = 70 20 born to substance abuse mothers 150 150 or 47% or 47% 5 born to HIV+ mothers 5 born to HIV+ mothers 10 born before 37 weeks 10 who are multiples 5 spent time in NICU Denominator =150 April 14, 2016 19 April 14, 2016 20 5
4/14/2016 Hospital Example for PC-05a Hospital Example for PC-05a 21 22 Of 150 in denominator: PC-05a Percentage of infants exclusively breastfed 50 moms didn’t want to breastfeed at all** excluding mother’s who chose at admission to not 20 who wanted to breastfeed but got formula at mother’s breastfeed request 10 10 got formula for “medical reason” (e.g., dehydration and f l f “ di l ” ( d h d i d other reasons not found on exclusion list) 70 Numerator remains the same = 70 100 or 70% Denominator takes out the 50 moms who don’t want to breastfeed at all = 100 April 14, 2016 21 April 14, 2016 22 Looking at the Gap Timeline PC-05 and PC-05a 23 24 • 2010 Hospitals started collecting data and submitting their data to TJC 47% vs 70% • September 2011 – TJC released hospital perinatal aggregate data for the 5 measures in the Perinatal aggregate data for the 5 measures in the Perinatal Care Core Measure Set (more details to come later How will your facility address the gap? in the presentation) April 14, 2016 23 April 14, 2016 24 6
4/14/2016 Data Reported Publicly at Your Facility Plans - QualityCheck.org Questions to ask… 25 26 • Who will collect this data? • Where can this data be found? • How do we assess a mother’s feeding preference? • Ways to phrase the question? • Ways to phrase the question? • Who asks the mom? Other questions? April 14, 2016 25 April 14, 2016 26 Step 6 Evaluation Criteria Electronic Health Records 27 28 • Exclusive breast milk feeding • Data collection recommendations coming • Compare its annual rate of supplementation to – USBC CDC NIS Data – Baby-Friendly USA – NICHQ NICHQ • Year-by-year reduction in non-medically Y b d i i di ll indicated supplementation Feldman-Winter, J Hum Lact, 2013 7
4/14/2016 Resources 29 Joint Commission https://manual.jointcommission.org United States Breastfeeding Committee Implementing TJC Core Measure on Exclusive Breast Milk Feeding www.usbreastfeeding.org April 14, 2016 29 8
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