Online Program

A statewide perinatal quality improvement collaborative to increase exclusive breastfeeding at hospital discharge

Wednesday, November 6, 2013 : 8:48 a.m. - 9:06 a.m.

Julie Ware, MD, MPH, FAAP, FABM, IBCLC, All Better Pediatrics, Cordova, TN
Karen Schetzina, MD, MPH, FAAP, Department of Pediatrics, ETSU, Johnson City, TN
Brenda Barker, M. Ed., Tennessee Initiative for Perinatal Quality Care, Nashville, TN
Peter Grubb, MD, Department of Neonatology, Vanderbilt University School of Medicine, Nashville, TN
Background: Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative that elected to develop a project to address Tennessee's low breastfeeding rates, funded by the Tennessee Department of Health. Objective: To improve the health of Tennessee infants and mothers by increasing initiation and duration of breastfeeding through systematic implementation of high reliability (>90%) processes that promote and support breastfeeding in the delivery setting. Methods: A toolkit was created using the evidence-based practices of the Ten Steps to Successful Breastfeeding and the USBC's Toolkit, “Implementing The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding.” 11 hospitals in Tennessee are currently participating in the project. Results: Participating hospitals established an improvement team of stakeholders, and began reporting exclusive breastfeeding at hospital discharge, according to The Joint Commission (TJC) guidelines. The centers are implementing one or more of the 10 Steps to Successful Breastfeeding by using rapid Plan-Do-Study-Act (PDSA) cycles. Reliability of implementation is monitored by process measure audits. Web-based data-entry through REDCap provides on-demand run-charts. Monthly webinars facilitate sharing of best practices between geographically distant centers. Baseline data in the first 5 months of the project from over 7000 maternal-infant dyads highlights improvement opportunities on all 10 steps. Conclusions: This project serves as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate implementation of evidenced based practices to increase breastfeeding rates across a large geographic area in a region of the country with disparately low rates of breastfeeding. Opportunities for leveraging project support from diverse stakeholders, including policy makers, insurers, and healthcare administrators will be discussed. Implementation and data collection challenges faced by hospital teams and workable solutions that emerged through the collaborative process will be outlined.

Learning Areas:

Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe how delivery centers in a statewide quality improvement collaborative in Tennessee are engaged across a large geographic area in systematically implementing high reliability(>90%) processes that promote and support breastfeeding in the delivery setting.

Keyword(s): Breastfeeding, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am one of the Tennessee Chapter Breastfeeding Coordinators, and a member of the Breastfeeding Promotion Leadership Team f TIPQC (Tennessee Initiative for Perinatal Quality Care). I have assisted in the creation of the Prenatal and Delivery Breastfeeding Toolkits for TIPQC.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.