Improving Support Of Breastfeeding At A Baby-Friendly™ Designated Hospital In Albuquerque, New Mexico

Abstract

Purpose: Breastfeeding has conclusively proven to be the healthiest feeding option for infants. Baby-Friendly™designated hospitals and birthing centers follow the Ten Steps to Successful Breastfeeding, which are considered to be the gold standard for supporting mothers who wish to breastfeed. However, even a Baby-Friendly™designated hospital may have room for improvement. The University of New Mexico Hospital (UNMH) is an urban hospital serving a predominantly Hispanic and Native American population, and the majority of pediatric patients are covered by Medicaid. Despite its Baby-Friendly™ designation, UNMH had low rates of physician documentation of discussing the health impacts of breastfeeding in the postpartum setting and discussion of home visitation prior to discharge. We aimed to improve these measures using the Plan-Do-Study-Act (PDSA) model. Methods: We conducted this study from August 2018 to August 2019 in the UNMH Mother Baby Unit. Providers reviewed 61 to 86 charts for each of four medical record reviews (MRR). Based on the results of the first two MRRs, providers decided to focus on increasing home visitation referrals. After the third MRR, providers worked to increase discussion and documentation of the health impacts of breastfeeding. Changes made included creation of a discharge planning checklist, modifying admission and discharge templates, educating attending and resident physicians via emails, meetings, chart reviews, and bulletin boards in the team room, and adding home visitation referral forms to all patient charts. Results: Over the one year study period, rates of discussing home visitation status increased from 49.2% to 89.2%. The rates of discussing health impacts of breastfeeding increased from 31.1% to 86.5%. Conclusions: Implementation of these quality improvement measures resulted in substantial gains in several key breastfeeding metrics, despite having already earned the designation Baby-Friendly.™ All hospitals, including those that are designated Baby-Friendly™, should consider supporting breastfeeding through ongoing quality improvement initiatives