Purpose for the Program
Guidelines support exclusive breast milk feeding starting within the first hour of life. This goal ignited passion for change at this 550-bed community teaching hospital with 3,200 births per year, which fueled ideas to meet the Joint Commission's standards and to provide patients with evidence-based practice, while increasing our rate of exclusive breast milk feeding.
A multifaceted, multidisciplinary approach to change the culture of the entire family care service focused on medical and nursing staff interventions, processes for care, environmental changes, and maternal education. We started with an exclusive breast milk feeding rate of 32% and a goal of 50%. Our initiation rate was 79% proving patient interest but illustrating the need for changes targeted at sustaining exclusive breast milk feeding.
Implementation, Outcomes, and Evaluation
Pediatricians were included in education and signed a contract agreeing to support exclusive breast milk feeding. Lactation consultants worked with pediatricians regarding discharge planning and with obstetricians for management of mastitis, engorgement, inadequate supply, and pain. Nurses and lactation consultants formed a breastfeeding committee to discuss concerns and roadblocks. They developed consents for mothers to sign for formula supplementation and encouraged mothers to provide expressed breast milk instead of formula. To expand lactation consultant services, all lactation consultants carried phones with coverage on a daily basis, inclusive of all shifts. Staff and mothers were dissuaded from providing pacifiers except during painful procedures. Lactation consultant triage practice was developed starting in labor and delivery to follow high-risk infants from birth to discharge. Labor and delivery nurses started routine breastfeeding education on admission, and now provide expressed breast milk to infants unable to breastfeed. Staff was updated on exclusive breast milk feeding rates routinely. Readmission rates of newborns fell after implementation of strategies. Nursing orientation in all obstetric areas now includes 8 hours with a lactation consultant. We stopped providing formula gift bags to exclusive breast milk feeding patients. An outpatient lactation clinic was opened to assist with follow-up care. This clinic is open daily inclusive of weekends and holidays to ensure that feeding, infant, and maternal assessments can be readily accomplished. The clinic is open to the community, and it rents breast pumps and sells breastfeeding supplies. Education and support increased and continues for staff, physicians, and the community. Deviation from the policy is not tolerated by nursing or medical directors. Our current initiation rate is 83% and the exclusive breast milk feeding rate is 68%.
Implications for Nursing Practice
Multiple factors fueled the fire and increased passion for change. Although many were reluctant to embrace this change, the passionate nurses involved sparked the fire for improvement.