Discharge Planning. Building a Sustainable Lactation Support Network. A Community Based Model

Transcription

1 Discharge Planning Building a Sustainable Lactation Support Network A Community Based Model Lily Morales, MPHc, CHES, IBCLC Magdalena Estrada, LCCE, IBCLC

2 10 Steps to Successful Breastfeeding STEP #10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

3 Healthy People 2020 Objectives Maternal, Infant & Child Health Increase the proportion of infants who breastfeed: OBJECTIVE # OBJECTIVE BASELINE TARGET MICH 21.1 EVER 74% 81.9% MICH 21.2 AT 6 MONTHS 43.5% 60.6% MICH 21.3 AT 1 YEAR 22.7% 34.1% MICH 21.4 MICH 21.5 EXCLUSIVELY THROUGH 3 MOS EXCLUSIVELY THROUGH 6 MOS 33.6% 46.2% 14.1% 25.5%

4 Surgeon General s Call To Action Key Messages Prevention is the foundation of the public health system Close the gaps Between Breastfeeding Initiation Rates & Rates at 6 months Between Any Breastfeeding & Exclusive Breastfeeding Among Minority & Low Socioeconomic Communities Increase access to support & services Action 8: Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community

5 Out Patient Clinical Concerns Possible Referral Issues Breastfeeding Difficulty (Latch & Position) Flow Preference / Nipple Confusion Weight Loss / Weight gain Jaundice Dehydration Sore Nipples Not enough breastmilk / Combination Feeding Cultural Beliefs & Behaviors NICU discharges Readmissions Others (medical, surgeries, re-lactation, delayed onset of milk, etc )

6 Who s involved? Stakeholders

7 Innovations & Collaborations Working Together Out Patient Support Consent Form: HIPAA Compliance IBCLC Referral Form: Transmit the Info WIC Hospital Home Visit Pgm Clinic

8 Options for Underserved Communities Community Based Model For Breastfeeding Support

9 Innovations & Collaborations Working Together Hospital Grade Pump Rental Verify Insurance Coverage HMO/PP O POS/EPO Obtain Authorization Medi-Cal WIC Patient Obtain a doctor s Order Hospital/ Clinic Store HCPCS Code E0604

10 OPEN DISCUSSION QUESTIONS & COMMENTS

11 Contact Information Lily Morales, MPHc, CHES, IBCLC Baby Friendly Project Coordinator 1401 S. Grand Ave. Los Angeles, CA (213)

12 Eisner Pediatric & Family Medical Center

13 Community Breastfeeding Clinic Referral Sources Clinic Outreach- Team Hospital Appointments Self Referred clients Pediatric Department & OB Department Community Center Breastfeeding Clinic Hospital Lactation Consultant Welcome Baby Program & WIC

14 Eisner Pediatric & Family Medical Center Postpartum Outreach Hospital Postpartum Visits done daily Discharge Appointments given to EPFMC clients Pediatric within 4 days Infant Feeding/Lactation 1-2 WEEKS CPSP Postpartum Assessment 4 WEEKS 6 weeks Postpartum

15 EPFMC Breastfeeding Follow Up Criteria for Automatic Breastfeeding Consultation Appointments Difficulty breastfeeding in the hospital No milk, Baby does not like it It hurts Reasons reported for Early Breastfeeding Discontinuation. Only 10% of Pregnant women attend the Breastfeeding Class offered at EPFMC First Baby Factor identified as early discontinuation between hospital discharge and 2 weeks Postpartum.

16 EPFMC Breastfeeding Follow Up Outreach Workers Training Breastfeeding Benefits & Importance of Early Support Approaching Clients and Customer Service Computer appointment system

17 The Community -Breastfeeding Clinic Day and Hours of Service Set Up in Conference Room

18 The Community -Breastfeeding Clinic Supervision by MD/CNM Prescriptions provided if needed, Pediatric reports and referrals done Inter referral opportunity and convenience Via , call, form or sending over client Chart Documentation for Mother and Infant Billing : CPSP Health Education Allowed 1 hour of PP Education FQHC Status - Flat rate per visit

19 Breastpump Referrals & Support History- Hospital Rental Station Eisner FQHC- unable to bill for DME Health Net Pilot CHMC, WIC, Eisner APRIA Only HMOs Prescription and Diagnosis Required WIC: - NICU & working full time mothers Referral Faxed to main office Navigating WIC Patients do not know PHFI or SLAPH

20 Welcome Baby Program Collaboration Nurse home visit first week Impact on Breastfeeding Rates reported % Exclusive Breastfeeding at 1 week 36% 1-2 months 35% 3-4 months EPFMC enrollments to Welcome Baby are 35 per month Impact on Breastfeeding Clinic Appointments 50% less appointments Patients consider unnecessary if a nurse is visiting them at home One third of our deliveries are enrolled in Welcome Baby Two thirds still need help.

21 Lessons Learned: Work Together Mother s If If the baby wants it, If it is possible, If I have milk Perception of Help or Support Yes, I had help I got a breastpump, nipple shield or pillow I tried,but it did not work

22 The Future I2i Breastfeeding Tracking Initiated January % Rates at 1 Week, 6 weeks 6 months Where are clients finding help? - Clinic, WIC, Welcome Baby Are we a Baby Friendly Medical clinic?

23 OPEN DISCUSSION QUESTIONS & COMMENTS

24 Resources AAP. (2011). Coding for Breastfeeding and Lactation Services. Retrieved from Centers for Disease Control and Prevention. (2010). Breastfeeding Report Card United States, Retrieved from CNN. (2011). Surgeon General Encourages Breastfeeding. Retrieved from min.cnn.html Office of Disease Prevention and Health Promotion (2011). Maternal Child & Infant Health Topics & Objectives. Retrieved from shttp://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26 U.S. Public Health Service Office of the Surgeon General. (2011). The Surgeon General s Call to Action to Support Breastfeeding. Retrieved from ng.pdf