The EHM Well Odyssey

April 10, 2013

EHM Well Baby Goal: Increase exclusive breastfeeding rates by 50%

Focus EHM Well

Skin to skin in DR The power of hand expression Skin to skin in postpartum Increasing Lactation Support
Staff education Lactation specialists

Removing formula Reducing separation of mom-baby Reducing pacifier use

Close to Me
Partnership with March of Dimes Bilingual education for families & staff Educational materials Equipment

EHM Well Enrollment

EHM Well: Newborn Dsicharges
2038.7 1838.7 Aggregate Monthly Discharges 1638.7 1438.7 1238.7 1038.7 838.7 638.7 438.7 238.7 UCL CL LCL 538.246 473.00 407.754 1625.538 1509.000 1392.462

Oct '10 - Mar '13

SPC Charts
Determining Significance
1 point outside the upper or lower control limits 2 of 3 successive points in the outer third of the control limit 8 successive points above or below the center line 6 consecutive points increasing or decreasing
Benneyan JC, Lloyd RC, Plsek PE Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12(6):458464

EHM Well: Breastfeeding Support

80% 70% % Receiving BreasCeeding Support 60% 0.5525 50% UCL 40% 30% 20% 10% 0% CL LCL 0.484 0.4146

EHM Well: BreasCeeding Support

0.6565 0.6368 0.6171

78% Increase in Breas:eeding Support (Comfort, posiFon, latch, transfer)

IniIaIve Months

EHM Well: Skin to Skin in L&D

0.800 0.700 0.600 0.500 0.400 0.300 0.200 0.100 0.000

EHM Well: Skin to Skin

0.7153 0.649 UCL CL LCL 0.5836 0.7202 0.6784 0.6366

% Skin to Skin

33% Increase in Skin to Skin

IniIaIve Months

EHM Well: Pacifier Use

Pacier Use
0.350 UCL CL LCL ShiKs With Pacier Use 0.250

0.300

0.200

0.150

53% reducFon in pacier use

0.1385 0.1249 0.1114

0.100

0.050

0.000 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Mar-12 - Mar-13

EHM Well: Hand Expression

EHM Well: Hand Expression
0.600

% Moms DemonstraIng Hand Exp[ression

0.500

0.5104 0.442 0.4228 0.3794 0.3360

0.400

0.3734

0.300

0.200 UCL CL LCL

542% increase in hand expression

0.100

0.000

Oct '10 - Mar '13

EHM Well:Breastfeeding Support

80% 70% % Receiving BreasCeeding Support 60% 0.5525 50% UCL 40% 30% 20% 10% 0% CL LCL 0.484 0.4146

EHM Well: BreasCeeding Support

0.6565 0.6368 0.6171

78% Increase in Breas:eeding Support

IniIaIve Months

EHM Well: Postpartum Skin to Skin

0.600

EHM Well Postpartum Skin to Skin

0.4926 0.4722 0.4518

0.500

0.4771 0.444 0.4116

% ShiKs With Skin to Skin

0.400

UCL CL LCL

0.300

33% increase in Postpartum STS

0.200

0.100

0.000

Months

EHM Well: Shifts < 1 Hour of Separation

EHM Well: SeparaIon of Mom and Baby
80% 70% 60% Data1 - Data2 50% 40% 30% 20% 10% 0% UCL CL LCL 0.4840 0.416 0.3480 0.6706 0.6898 0.6513

53% Increase In Rates of ShiZs with <1 hour of separaFon

Oct '10 - Mar '13

Shifts With < 1 Hour of Separation

African American Mothers Intention to Breastfeed

Intention to Breastfeed All

EHM Well: Mothers Intending to Soleyl Breastfeed Succeed

EHM Well: Exclusive BreasCeeding in Mothers Intending to BreasCeed
Exclusive BreasCeeding in Mothers Intending to BreasCeed 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Mar-12 - Mar-13 0.7647 0.7180 0.6714 UCL CL LCL

6% increase in exclusive breasfeeding in mother's intending to breas:eed

EHM Well: Exclusive Maternal Milk All

EHM Well: Exclusive BreasCeeding
60% 0.5348 50% UCL CL 40% % Soley Maternal Milk LCL 0.466 0.3971 0.5655 0.5208 0.4761

30%

20% Increase in Exclusive Breas:eeding

20%

10%

0%

IntervenIon Months

% Breastfed Infants Receiving Formula Before 2 DOL

35 30 25 20 NC 15 10 5 0 2009 2010 2011 2012 http://www.cdc.gov/breastfeeding/data/reportcard.htm US

Since 2010 38% reduction in formula for breastfed infants

Going Forward
This work must continue Data system will remain active Reports will be available QI Summer Patient and Family Engagement Next initiatives

What is my Units Culture?

The set of shared abtudes, values, goals, and pracFces that characterizes my unitor an insFtuFon, organizaFon or group