Ocho Pasos: A Quality Improvement Pilot to Improve Outpatient Clinic Breastfeeding Support

Abstract

Purpose of Study: Only a third of US mothers achieve three months of exclusive breastfeeding (BF) despite the American Academy of Pediatrics (AAP) recommendation to exclusively BF for six months. National experts have recently published evidence-based guidelines for outpatient clinics to support longer durations of BF. Our pilot study sought to evaluate the feasibility of an intervention to improve support for BF in outpatient primary care clinics. Methods Used: We compared evidence-based BF-friendly guidelines from the AAP, Academy of Breastfeeding Medicine, California’s 9 Steps, and Washington’s 10 Steps to create Ocho Pasos (Eight Steps),guidelines tailored to the New Mexico population. In 2018, we recruited an outpatient primary care clinic in rural New Mexico to participate in a 6-month pilot program using the Ocho Pasos as a framework to evaluate the clinic. After establishing a baseline for clinic practices, we focused on improving medical record documentation of BF supportive care through two Plan-Do-Study-Act (PDSA) cycles. Approximately 40 medical records were reviewed at baseline and at each subsequent medical record review (MRR). Summary of Results: Providers and staff set a goal to improve documentation of mothers’ intended BF duration. This documentation improved from 0% at baseline to 63.0% and 91.3% at the second and third MRR, respectively. A majority (16/17, 94.1%) of mothers surveyed after their infants’ well child checks reported discussing their intended duration of BF with their provider. Overall, providers and staff reported the quality improvement initiative was feasible and acceptable in terms of processes and instruments; however, staff did request that fewer medical records be reviewed to reduce the time burden. Conclusions: Our preliminary findings suggest that quality improvement initiatives aimed at implementing evidence-based practices for BF support in an outpatient setting are feasible. We plan to refine this initiative for future efforts in New Mexico