utilizing joeybands during postpartum period to increase...
TRANSCRIPT
Utilizing Joeybands During Postpartum Period to
Increase Exclusive Breastfeeding, Patient
Satisfaction & to Decrease Infant Falls
May 2018
Kelley Reddington, MSN, RN, RNC-EFM-OB-EFM, CNML - Nurse Manager, Labor & Delivery
Theresa Davis, BSN, RN, RNC-EFM -Nurse Manager, Women’s Care Center
Monique Samuels, BS, RN, RNC-EFM – Assistant Nurse Manager, Women’s Care Center
Eileen Tarney, BS, RN, RNC-EFM – Assistant Nurse Manager, Labor & Delivery
Elizabeth Cunningham, MSN, RN, RNC-EFM – Perinatal Clinical Nurse Specialist
Elizabeth Seaman, RN, IBCLC, Lactation Specialist, Certified Childbirth Educator
Debra Stone, RN, IBCLC, Lactation Specialist
Susan Marsh, RN, IBCLC, Lactation Specialist
Labor & Delivery Unit Nursing Team
Women’s Care Center Nursing Team
Mary Christoffersen, RN, BSN, MBA, CNOR, Vice President, Nursing, Patient Care Operations and Emergency Services
Diane Youd, RN, BSN, MBA, CNOR, Director, Nursing & Patient Care Operations
MaryEllen Hope Kosturko, MAHSM, BSN, R.N., Sr. Vice President Patient Care Operations/CNO
Objectives
− OVER A 5 MONTH INITIAL PERIOD:
1-INCREASE THE EXCLUSIVE IN HOSPITAL BREASTFEEDING
RATE
2. DECREASE NEWBORN FALLS
3. MEASURE PATIENT OVERALL SATISFACTION WITH SKIN TO
SKIN EXPERIENCE WHEN USING THE JOEYBAND
Methods
Measures Press Ganey patient satisfaction survey
Joeyband Satisfaction Survey
EMR computerized data for exclusive breastfeeding rates and newborn falls
Patient Survey
Improvement Strategies/Interventions All postpartum women delivering vaginally or via cesarean delivery were given a Joeyband skin to skin securement device & provided
education regarding its use.
Plan, Do, Study, Act quality improvement tool was used.
Bridgeport Hospital – Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
% Exclusivey Breastfed % Breastfeed within 60 Min of Birth % Inititating Breastfeeding
24%
42%
85%
32%
49%
86%
8.2% 7.0%1.0%
Well Baby Breastfeeding Statistics
Aug-Dec 17 Average Jan-May 18 Average % Improvement
Bridgeport Hospital – Breastfeeding Statistics
Intervention
2226
21
30
22 24
3228 27
37 3732.2
4247
4339 38
42
50 4842
5054
49
88 86 84 82 84 8582
8682
89 9086
0
10
20
30
40
50
60
70
80
90
100
Aug-18 Sep-17 Oct-17 Nov-17 Dec-17 Sept-Dec17
Average
Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jan-May18
Average
Bridgeport Hospital Breastfeeding Statistics
% Exclusively Breastfed % BF Initiation Within 60 of Birth % of Mothers Initiating BF
Bridgeport Hospital – Infant Fall Rate
3
00
1
1
2
2
3
3
4
2017 2018 (YTD)
# Infant Falls
Fiscal Year 2017 vs Fiscal Year 2018 (YTD)
26
45
86
28
45
85
0
10
20
30
40
50
60
70
80
90
100
% Exclusivey Breastfed % Breastfeed within 60 Min ofBirth
% Inititating Breastfeeding
Fiscal Year Data
2016 FY 2017 FYTD
Press Ganey Patient Satisfaction
93.5
95.6
64%
90%
90
91
92
93
94
95
96
97
98
99
100
Sept 17-Dec-17 Jan 18-May 18
Overall Rating of Care – by receive date - % rank against large PG database in OB/GYN
Press Ganey - Overall Rating of Care Given PG % Rank
N = 112
N = 125
2.1 increase in score26% increase in PG % rank as compared to large PG database
Joeyband Survey Objective Data
24
63
15
3 10
10
20
30
40
50
60
70
1st Baby 2nd Baby 3rd Baby 4th Baby 5th Baby
What number baby is this for you: N = 106
1
31
49
10
10
20
30
40
50
60
□15-19 □ 20-29 □ 30-39 □ 40-45
My Age is:
How often did you use the Joeyband while you
were in the hospital?
21
43
15
0 5 10 15 20 25 30 35 40 45 50
□ 2-4 times a day
□ 1-2 times a day
□ I didn't use it
How often did you use the Joeyband while you were in the hospital ?
The instructions on how to use the Joeyband were
clear
47
18
51
0
10
20
30
40
50
60
1/2 3 4 5
The instructions on how to use the Joeyband were clear (Rating 0-5)
The Joeyband was easy to use
4
12 13
51
0
10
20
30
40
50
60
1/2 3 4 5
The Joeyband was easy to use
The Joeyband provided warmth & comfort to my
baby
2
10
16
48
0
10
20
30
40
50
60
1/2 3 4 5
The Joeyband provided warmth & comfort to my baby
The staff was able to explain the benefits of skin to
skin care
0 2
11
60
0
10
20
30
40
50
60
70
1/2 3 4 5
The staff was able to explain the benefits of skin to skin care
I am likely to continue using the Joeyband when I
return home
0
1114
52
0
10
20
30
40
50
60
1/2 3 4 5
I am likely to continue using the Joeyband when I return home
Overall satisfaction when using the Joeyband
27
16
49
0
10
20
30
40
50
60
1/2 3 4 5
Overall satisfaction when using the Joeyband
Joeyband Survey Subjective Data
COMMENTS:
− Not possible to use alone
− Velcro was very scratchy and rough
− Haven't used it but love the idea and can't wait to use it
− During c/s recovery for skin to skin time. Great!
Discussion
8.2% in overall exclusive breastfeeding rates
7% increase in initiation of breastfeeding within 60 min of birth
1% increase in our initiation of breastfeeding.
We had no infant falls since implementation as compared with 3 during the 2017 year.
Our Press Ganey Overall Rating of Care increased 2.1 points since our go live & a 26% increase in our rank as compared to other hospitals of like size
Our subjective data also supports our patients desire to use skin to skin to better bond with their baby & to maintain importance of safety infant fall risk while in the hospital & beyond as they can take the device home with them.
Data suggests that combined with education & continuous support our Mothers & Babies utilization of the Joeyband helps support bonding, safety & satisfaction during their postpartum stay.
Study Limitations include concurrent measures to enhance the patient experience & align with evidenced based practices. Our postpartum area started transitioning to couplet care (same RN for Mom/Baby) during our study in February
Implications for Yale New Haven Health
Though our funding was initially started with a grant fund request, our
goal is to make this evidenced-based practice by giving all of our
Moms/Babies across YNHHS a Joeyband to utilize & take home. This
will help achieve our YNHHS mission of achieving excellence in
innovation and service to our community.
References
− Haxton D, Doering J, Gingras L, Kelly L. Implementing skin-to-skin contact at birth using the Iowa model: applying evidence to practice. Nurs Womens Health. 2012;16(3):220-9.
− March of Dimes. Kangaroo care Accessed 3/10/2016
− Brimdyr, K, Cadwell, K, et al, (2017). An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth. Maternal & Child Nutrition, doi.org/10.1111/mcn.12571
− Lau, Y, et al (2017), An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation, Maternal & Child Nutrition, DOI: 10.1111/mcn.12492
− Charpak, N (2016), Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 139(1):e20162063
− mothers and babies, regardless of feeding preference. The authors argue that unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes.
− Crenshaw, JT, (2014). Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby, and Breastfeeding, Journal of Perinatal Education, doi: 10.1891/1058-1243.23.4.211
− Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Geeta Gathwala, Bir Singh, and Jagjit Singh, Trop Doct. 2010; 40(4): p. 199-202.
− Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). In: The Cochrane Library, Issue 2 2003. Oxford: Update Software.