A Standardized Communication Approach to Promote Exclusive Breast Milk Feeding

Introduction: Breastfeeding is recognized and promoted by the AAP and ACOG as an important factor in neonatal growth and development, with numerous short- and long-term health benefits for both mother and baby, including ideal nutrition, decreased rates of childhood infections and atopic disease, and improved postpartum recovery. Focused review of the current literature yielded studies detailing barriers to successful hospital breastfeeding exclusivity, including disparities in provider knowledge and attitudes. Our children's hospital is a BabyFriendly designated hospital with 4,800 deliveries per year. In late 2016, our breastfeeding exclusivity rates decreased from 50% to 44% which prompted gap analysis and process improvement. Aim Statement: Our goal was to increase exclusive breast milk feeding rate (JCAHO measure PC-05) from a baseline of 44% (Q4 2016) to a rate of 48% by December 2017, with a stretch goal of 50%. Methods: An interdisciplinary team consisting of pediatricians, hospitalists, nurses, nursing educators, housestaff and lactation consultants was formed to expand the existing breastfeeding committee. Brainstorming sessions identified standardization of communication with the mother and family as the primary target for process improvement. Breastfeeding education using user friendly, pictographic flipcharts as bedside teaching tools was used as a key driver to standardize communication. In July 2017 a "Breastfeeding Luau" was held to introduce the new flip chart, educate and motivate buy-in from the frontline staff. Flipcharts were distributed and made available at every point of care. Data was displayed in a unit-based dashboard to increase awareness and demonstrate ongoing data results. Interventions were carried using a series of Plan-Do-Study Act cycle. Analysis: PC-05 data was abstracted monthly from hospital admission records. Mothers were surveyed during breastfeeding classes to assess whether they received education using the flip chart. This was used as our primary process measure. Minitab 18.0 software was used to analyze data. Results: Breastfeeding exclusivity rate increased from a mean of 44% to 47.6%. There was a statistically significant improvement in the proportion of mothers who did not receive standardized education using a flipchart (p