Karen Peters and Suzanne Haydu are going to talk about what has been happening in the state with hospitals and QI Improvement.
Suzanne explains that she works within the state and was working with the Maternal Child Health area and breastfeeding rates. The funding came from Title V funding. They worked in this area because there were areas within CA that maintain very poor breastfeeding rates. She shows a map broken into the Regional Perinatal Programs because they work on QI with laboring and delivering hospitals in these areas. The central valley and in LA and Orange County these rates were very poor compared to others. Also the key was difference in any and exclusive breastfeeding. We expect this gap to be small but it is not. Investing in CA's Future did have a recommendation that hospitals and clinics promtote exclusive BF for the first 6 months of life. There is a particular strategy that states that we maintain and disseminate model hospital policies and promote this. The model hospital policy recs were developed by the Regional Perinatal Program in Loma Linda and the toolkit was developed by Jeanette Panchula who was hired by the state to build this; many links and resources. see cdph.ca.gov/breastfeeding for this area.
All information is on the CDPH website for hospitals. Some years ago some money was given to work with hospitals in these worse areas to develop the Birth and Beyond California Program. Developed from Loma Linda with Carol Melcher's project and it had 3 areas: must have a QI team where policies are being worked on, training in boht a 2 hour pre-meeting and then 16 hours with 20 staff members and then another 16 hours of 4 of those staff to be train the trainers, the last was that each hospital met as a group once per month to share successes and issues with each other. The state gave data and technical support and regionally IBCLC's to give training to hospitals as well as PACLAC who had a large pool of IBCLC's to assist with program.
Hospitals had to apply and compete for program. It started with a self appraisal questionnaire, pre and post tests, self efficacy surveys, and we then gave the hospitals a data collection template. We could not mandate that but we assisted them to getting the data.
MCH was hit with the wirst cuts and the program was cut, but LA is making a report and trying to keep it alive through that.
Karen Peters explains that we thought the program would work because of the research. The CDC survey parallels the information we wanted and we hope to work more with that. Rosenburg tells us that what happens in the hospital stay makes a difference. At start we asked that CEO's as well as others be in the room, along the way we found that we needed the CEO and CNO were involved from the start the outcomes were better. We also knew that data over time was better, so we had the template to keep track. Most staff said that their patients were different. Anne Merewood shows us that all race and ethnic groups change when your policies were addressed. Murray showed that even at 8 weeks breastfeeding data was different when their were 5 practices shown; BF at one hour at birth, no pacifier, rooming in, exclusive feeding at hospital, and having a number to call. Also Oregon showed us that even banning the formula gift bag raised rates.
We then tried to make environment better to help mother. So we need to keep moms and babies together; skin to skin. This is for the well being of both, and nurses work to keep this couplet stable. It has been an easy sell because everyone likes it. It increases our infants ability to feed. Moms, Dads, and babies love it. We then have a positive spiral of feeding babies with less problems. We encourage maternal confidence by doing all of this as well. We found that hospitals increased more policies and their feeding data changed as policies changed. There are more working on and have changed in 6 months than before. The chart she showed does not look at feeding but looks at model policies they are working on and doing. We cannot compare this to their data because we were not able to ask them about feeding.
Panel member asks about data: Karen explains that we look at skin to skin, rooming in and exclusive breastfeeding.
Panel member asks how many hospitals: Karen explains that there were 3 cycles with different numbers every time in all 3 regions.
Karen goes onto explain that we sold skin to skin and infant and maternal competence. We found we needed to help and make infant safety their priority; safe in arms and monitored. It is a systems change program, not a breastfeeding program. The network meetings were critical. Nurse share how well it worked and areas they work on one at a time. Most hospitals only collect data on patient satisfaction. We want the QI people there because they know what they are doing. Data is essential, we encourage them to do so and look at sustaining and how they continue to support project. Some went baby friendly in the process because they needed help with sustaining. All hospitals did move on to train others at their hospitals. No one objected to skin to skin before bating the baby; nurses or docs. Patients did not need the skin to skin and visitors did not object to not seeing baby right at birth. The Golden Hour was respected...as it has come to be called.
Joint Commission has accepted the exclusive breastfeeding as a standard as a quality measure as of 2009. Lets build on this and work on maternity care. All materials will be on the website and available for use, even a report later this year!
Bonnie added that Carol Melcher began this in Loma Linda....everyone applauded!
Carol Melcher shares that what we found is what she found.
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