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A Timely 1st Latch for Breastfeeding Team Members Dr. John Gianopoulos, MD Pamela Allyn, RN, IBCLC Maureen Davey, RN Patricia Karczewski, RN, IBCLC Katherine McGee, RN, IBCLC Sandra Swanson, RN, MSOD Labor and Delivery Staff Nurses Applicable Magnet Forces: Force 7: Quality Improvement, Force 11: Nurses as Teachers, Force 13: Interdisciplinary Relationships Confidential: Quality Improvement Material
Project Aim Statement Research supports the practice of initiating breastfeeding within one hour of delivery.16% of neonatal deaths could be saved if all infants were breastfed from day 1; and 22% if breastfeeding is started within the first hour of life. 1 The benefits of early initiation of breastfeeding include: • Allows for skin to skin contact between mother and infant, providing emotional support • Provides colostrum as infant’s first immunization • Takes advantage of the infant’s first hour of alertness • Infants learn to suckle more effectively • Increases duration of breastfeeding 2 Feedback from Loyola patients indicated a desire to breastfeed immediately after delivery. However, chart reviews indicated that this occurred only 63% of the time. Sources: (1) Edmond KM, et al. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality; Pediatrics 2006:117;e380- e386 (2) A Joint WHO/UNICEF Statement – Published by the World Health Organization, 1989 Confidential: Quality Improvement Material
Project Goal and Target Goal: To increase the percentage of mothers who are offered an opportunity to breastfeed immediately after delivery in Labor and Delivery prior to infant going to the nursery. Target: Offer and document breastfeeding assistance for medically stable breastfeeding mothers and infants. • Vaginal deliveries – 90% • Cesarean deliveries – 80% Confidential: Quality Improvement Material
Solutions Implemented Established eligibility standards related to medical stability of mother and infant • Exclusion factors for Mothers: • Life-threatening condition • General anesthesia for delivery • Hemorrhaging • Delivery taking longer than expected due to complications • Unstable condition per medical staff • Exclusion factors for Infants: • Life-threatening condition, such as prolonged rupture of membranes – over 24 hours • Maternal fever necessitating infant assessment • Transitioning difficulties • Respiratory issues • Hypoglycemia • Unstable condition per medical staff Provided education to all clinicians • L&D staff: latch assistance competency • Childbirth educator staff: promote early breastfeeding latch in prenatal classes • Pediatric resident and medical staff: researched-based rationale for early breastfeeding latch prior to infant’s nursery admission Confidential: Quality Improvement Material
Solutions Implemented Identified breastfeeding resources for Labor and Delivery staff • Daily rounds by Lactation Consultants • Increased presence and support of staff • Education to undelivered patients to encourage early latch • Staff nurse mentors identified for less experienced staff members Implemented consistent monitoring and feedback for staff • Charge nurses monitored daily compliance on a log sheet • Daily updates to the L&D Poster – “Perfect 1st Latch Days” • Posted chart audit results monthly • Individual counseling for non-compliance Celebrated our Success • Individual reward for compliance – Dove chocolates! • Individual thank you notes by Lactation Consultants “from infant to RN” for compliance • Breakfast celebration for exceeding targeted goals and achieving 100% for Cesarean deliveries Confidential: Quality Improvement Material
Analysis Results: • Vaginal deliveries – 90.6% compliance; target met • Cesarean deliveries – 86.8% compliance; target exceeded Factors contributing to our success: • Administrative support • Visible presence of Lactation Consultants in L&D • Established clear expectations and accountability for staff • Rewarding successes Confidential: Quality Improvement Material
Next Steps • Ongoing chart audits • Reinforce staff education • Continue feedback to individual staff members • April 2009 – celebratory rewards for compliance Confidential: Quality Improvement Material