Memorial Hospital of South Bend. Improving our mpinc scores

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1 Memorial Hospital of South Bend Improving our mpinc scores

2 Childbirth and Mother Baby Unit Patty De Stefano, MSN, RNC - OB Sarah Paturalski, RN, BS Emmy Ettl, RN, IBCLC

3 Memorial Hospital Childbirth Unit 70 RN s All eligible RN s are certified in Inpatient Obstetrics 70% are BSN prepared 2011 Births 2915 mpinc Score Births 2402 mpinc Score 89

4 Skin to Skin What Babies Want narrated by Noah Wyle Profound impact on CBU nursing 2006 Implemented Skin to Skin policy for vaginal deliveries Unable to get buy-in from Mother Baby to do rooming in

5 Skin to Skin in the OR 2012 pregnant Liberian war refugee comes to South Bend sees our midwifery group Greatest fear we will harm her baby Every patient on admission is asked her fears and concerns during the hospitalization Coordinated with surgical team we will do skin to skin immediately after baby is delivered Anesthesia, Obstetrician, Nursing collaboration

6 Skin to Skin in the OR Fall of 2012 set a goal - 25% of C/S patients will do STS in the OR during surgery Did not count if no support person, patient vomiting or just didn t feel well, and resuscitation 79% of patients were able to do so

7 Skin to Skin in the OR 2013 Quality Improvement Goal of STS during the C/S set at 75% Discussed during skills sessions in February buy in from nursing Didn t ask permission from physicians (we just did it) Per request from anesthesia, modified documentation to say support person educated on STS and keeping a hand on baby Some physician frustrations, ie baby s feet got in the way of the field, one anesthesiologist refused to let us do it Year end 2013, 89% of patients were able to do STS during their C/S

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9 Getting Mother Baby to Shift Their Paradigm New leadership on Mother Baby Unit late summer 2011 Decision made to apply for Baby Friendly Designation, December 2011

10 Memorial Hospital Mother Baby Dept. 45 RN s, 7 IBCLC/CLS All eligible RN s are certified: RNC-MNN, IBCLC, CLS 2011 Births 2915 mpinc Score Births 2402 mpinc Score 89

11 2011: Fresh Start New leadership Fresh start at goals Gaps identified Intent made for BFHI designation

12 2012 We banned the bag!! Began monitoring rooming-in times as a key performance indicator (publicly) Redesigned patient education materials We had to be persistent with other departments in the quest to not promote formula.

13 2012: Breaking down barriers & fears, cont Staffing mix changed No nursery nurse 3:1 instead of 4:1 Brought CBU/MBU together for a workout to decide how we would accomplish total room-in Initial newborn assessment moved to CBU RN responsibility Equipment at bedside in all MBU rooms Newborn bath delayed Task timeline Gone from vocab, Do you want us to take the baby to the nursery

14 2012: cont Created Lactation Coordinator Position Lactation consultant hours extended to cover evenings Lactation support group increased to twice a week CLS as an option for RN certification (11 CLS on staff)

15 Increased our community presence

16 2013: The new norm Admission process became stable (no separation) Rooming-in was the new norm CBU began educating on rooming-in along with STS Began tackling the FORMULA situation Worked on pricing Monitoring supplementation and pacifiers as our key performance indicator Coaching & holding accountable individual outliers

17 2013: Massive Education Effort Department meetings: constant focus on breastfeeding & factors that affect All departments Housewide CBL Hospital open house Dr s offices Coalition booklet MBU & CBU: 20 hours lactation education 5 hours of observation/hands on with LC Prenatal breastfeeding class included: Rooming-in, STS, exclusivity & avoiding pacifiers

18 2014: We do not accept ANY free formula Continued accountability (our practice is not changing ) Highlighted patient stories Breastfeeding classes became free! Dr s, midwives, and practitioners completed 3 hours of breastfeeding education Mock BFHI interview

19 Where are we today? We room in. The nursery holds supplies. Our frontline staff are great lactation troubleshooters. We still have some struggles. Not all Dr s love our new model Not all patients love our new model Some patients state they feel guilty not breastfeeding