Mary Ellen Boisvert, RN, MSN, CLC, CCE Nurse Manager, Family Centered Unit Tobey Hospital Southcoast Hospitals Group

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1 Mary Ellen Boisvert, RN, MSN, CLC, CCE Nurse Manager, Family Centered Unit Tobey Hospital Southcoast Hospitals Group

2 Demographics Tobey Hospital Wareham, MA Community Hospital, Level 1 Southcoast Hospitals Group Approximately 500 births/year

3 Demographics Our Unit Family Centered Unit LDRs 3 Labor/delivery/recovery Rooms 1 Triage bed 1 C- section room 6 Postpartum Rooms Normal Newborn Nursery C- section Rate Primary: 11% Overall: 19% Epidural Rate: 25%

4 Demographics Our Staff Staff 3 RNs per shift 33% of RN staff are CLC or IBCLC 1 OB Multi- functional Worker per shift Medical Staff No hospitalists, no laborists, no neonatologists Obstetric and pediatric providers Private practice 4 obstetricians, 1 CNM 3 pediatricians

5 Our Culture Shared Values Trust in the birth process Natural Interventions less is more Focus on outcomes Healthy mom and baby What is in the best interest of the patient(s) Labor process effects newborn transition

6 Our Baby- Friendly Journey: 2- year process April Perinatal Advisory Committee- Recommendation as a quality initiative May 2009 Self- assessment July Certificate of Intent August Action Plans Developed April Baby- Friendly USA assessment 2 assessors 2 days May 2011 Awarded Designation!

7 Banning the Bags!!!! Took the formula out of the bags for breastfeeding moms Formula representative said we can t alter their bags Stopped giving formula bags to breastfeeding moms Did not make sense.so we banned them! Opportunity to Stop and Think Why are we supporting someone else s brand? Stopped using all products with formula company logo Crib cards, growth charts, measuring tapes

8 Banning the Bags!!!! Stopped in- unit education sponsored by formula representatives Stopped all visits from formula reps Dropping in to check on formula floor stock Pre- scheduled appointment with manager was required No gifts of food for holidays, nurses week, etc

9 Banning the Bags!!!! Challenges Staff felt we needed to give patient s something if we were not going to give the formula bags Formula representative s unannounced visits Concerns about formula feeding mothers who run out of formula or who don t have any for discharge day

10 BreasBeeding Policy Policy reviewed via telephone survey with Baby- Friendly Breastfeeding policy submitted with other supporting policies & standing orders Newborn admission policy Hypoglycemia protocol Rooming- in policy Newborn thermoregulation policy Policy critique returned policy needed to be over hauled!

11 Skin to Skin Uninterrupted Vaginal delivery C- sections Statistics on length of time for uninterrupted S2S Average = 105 minutes Statistics on breastfeeding within 1 st hour Range = minutes Challenge with data gathering: Consistency in documentation

12 Pacifiers Education for staff regarding impact on breastfeeding success Education for all parents, regardless of feeding method, on importance of responding to feeding cues Set a date Challenges Reinforcing response to feeding cues support/ education for the family Habit- parents ask for pacifier so staff give them one

13 Rooming In Rooming In Longstanding history of care being provided under this model of care most of the time Worked with staff to improve delivery of care Education for staff regarding maternal/newborn sleep and rest patterns Couplet care philosophy initiated Pediatricians rounding in patient rooms Most newborn procedures done in the patient room

14 Rooming In Challenges Patients who gave birth in the past, may anticipate using a nursery Staff are uncomfortable saying no Staff perception that they will need more equipment Lighting in the room for the pediatrician s exam Procedures in the room will be disruptive to patients Documentation in the medical record

15 Paying for the Formula Calculated average percentage discount of items used in the hospital that can be purchased at retail Applied that average discount percentage towards purchase of formula High initiation rates and high exclusivity rates = lower formula use Challenge Corporate compliance apply cost to all 3 sites Difficult to get a bill from one of the formula companies

16 The Baby- Friendly Survey We prepared.and prepared. We were on meeting agendas Make everyone aware We told our patients Many wished they delivered during the survey We were excited, nervous, and excited!

17 The Baby- Friendly Survey Surveyors are well prepared and professional Opening meeting established the schedule for the 2 days The surveyors saw our practice in action Rooming in, educated patients, exclusive breastfeeding, tests and assessments done in the room, newborn lab draw done while at the breast, moms and babies skin to skin The surveyors heard our patients tell their stories Discharged patients came in to meet with surveyors or talked to them on the phone

18 Baby- Friendly Survey Lessons Learned Preparing staff for what to expect is well worth the effort Include the patients in the preparation Know what happens on your unit what really happens! Rewarding Experience!

19 Any Breastfeeding = 85% Exclusive Breastfeeding= 77%

20 Change Management This is how we have always done it Change is difficult Habits offer stability Fear of the unknown Feeling less competent Feeling that what we have always done is not good enough

21 TransformaMonal Leadership Communicate a sense of urgency Why now? Create a vision Consistent, clear message Establish a coalition Team effort, champions Remove barriers Celebrate wins! (Weber & Josai, 2000)

22 The Journey Transformation is a fluid process Can be unpredictable There are lessons to be shared Each hospital s journey is unique Culture provides a framework and guides behavior Understanding culture can help initiate change

23 Frederick Douglas

24

25 Thank You QuesMons?

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