EXPANDED HOSPITAL POLICY #1:

INTERVENTION / MANAGEMENT

RATIONALE

RESOURCES

1.1 Form an interdisciplinary, culturally appropriate team comprised of hospital staff including; administrators, medical staff, nursing staff, perinatal health educators, lactation specialist/consultants, and registered dietitians. Team members should join together to reduce institutional barriers to breastfeeding, such as mother-infant separation, fragmentation of care and routine supplementation. This team will be responsible for

1.1.1 developing, implementing, and monitoring hospital policies and practices.

1.1.2 ensuring ongoing education for all staff.

1.1.3 performing an evaluation (Word)based on guidelines similar to the Baby-Friendly Hospital Initiative Self Appraisal Tool.2

1.1.4 assuring support for pregnant and breastfeeding patients and hospital staff.

1.1 A multidisciplinary task force can bring a variety of perspectives. 4,8,9,10,19,20

1.1.3 Ongoing evaluation will assist the team in program implementation and planning. 2,6,7,12

1.1.4 Information from local experts and patients using the services will often be helpful.

Position Papers from various disciplines:

• American Academy of Pediatrics
• American Academy of Family Practitioners
• American Dietetic Association
• Association of Women’s Health, Obstetric and Neonatal Nurses
• International Lactation Consultant Associatio (PDF)
• National Association of Pediatric Nurse Associates and Practitioners

Summaries of state, national and international evaluations:

• Breastfeeding: Investing in California’s Future (Executive Summary (PDF)| Full Version (PDF, 3.8MB))
• HHS Blueprint for Action on Breastfeeding (PDF)
• Global Strategy for Infant and Young Child Feeding
• Protection, Promotion and Support on Breastfeeding in Europe: a blueprint for action (PDF)

Resources on Change and QI

• A team approach to Quality Improvement
• Implementing change: becoming baby-friendly in an inner city hospital. (Abstract)
• Example of a Daily Log (Excel)to be used when performing chart reviews for process improvement
• Stephen J. Zaccaro, Deanna Banks; Leader visioning and adaptability: Bridging the gap between research and practice on developing the ability to manage change. Human Resource Management, Vol 43 No 4: 367-380 (2004 Wiley Periodicals, Inc). (Abstract)

Sample Evaluation Tools

• Model Hospital Policy Evaluation tool (Word)
• Infant feeding chart review tool (Excel)
• Infant feeding audit too (Excel)
• Baby Friendly Hospital USA self-evaluation too (PDF) 

Resources lists (also see Policy #10)

• “Fill-in” list (Word)to begin a local resources list
• Wellstart International professional education, videos, handouts, etc.
• California Breastfeeding Coalitions (Word)
• International Lactation Consultant Association

1.2 Team members should review the International Code of Marketing Breastmilk Substitutes (PDF)

1.2 International concern exists regarding the marketing practices of artificial infant milk manufacturers. Accepting educational grants, teaching materials, gratuities, and gifts from artificial infant milk companies may indirectly endorse artificial infant milk. 1,24,25,26

• Physicians and Breastfeeding Promotion in the US: A Call for Action
• Overcoming the issue of accepting free formula
• Baby Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting (PDF)
• Perform a self-evaluation of your agency by using the “Office and Hospital Scavenger Hunt “ found in Appendix D (PDF)of the CPQCC Nutritional Support of the VLBW Infant: Part 1.                                

1.3 The team should designate a member to be responsible for assessing needs, planning and monitoring interventions, implementing, and updating competency-based training in breastfeeding for all staff caring for mothers, infants, and/or children.

1.3 Ongoing training is essential to maintain staff competency. The level of competency required and/or needed should be based on staff functions, responsibilities, and previously acquired training, and should include documentation that essential competencies have been mastered. 3,5,11,13,21,22,23

• ILCA’s Independent Study Modules (CERP and CEUs available) are derived from original manuscripts, articles in the JHL, ILCA conference sessions, and notable publications.
• Kaiser Permanente Baby Start Educational Programs
• Professional Distance Learning Course listings
• Staff competencies & logs
• “Nursing Competencies “are found in Appendix D of the CPQCC Nutritional Support of the VLBW Infant: Part II
• Clinical Competencies of the Lactation Consultant (PDF)

1.4 All hospital departments serving mothers, infants, and/or children should have written breastfeeding policies that are routinely communicated to all health care staff, beginning with hospital orientation.

1.4 Ongoing reinforcement of policies is essential to maintain competence. 17,20

Sample Policies and Protocols:

• Academy of Breastfeeding Medicine: http://www.bfmed.org/
• Peripartum Breastfeeding Management for the Health Mother and Infant at term (PDF)
• Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother (PDF)

1.5 Nurses coming in contact with mothers, infants or children should receive standardized education and training on the support and management of lactation. Lactation management should be included as part of orientation and included as part of ongoing training and competency evaluation for both nurses and physicians.

1.5 Training will assist nurses in using common terms and standard recommendations.

Mothers are often confused and frustrated when receiving varying advice. Eighteen hours of education (15 diadactic, 3 clinical) [Link to new Baby Friendly Initiative Courses] is the minimum amount of lactation training recommended by the by the World Health Organization (WHO). 5,11,12

• Courses accredited by the International Lactation Education Accreditation Council (ILEAC) of the International Lactation Consultant Association (link)
• Kaiser Permanente BabyStart Educational Programs.  This evidence based staff training program is an interdisciplinary breastfeeding management course specifically designed for hospitals and clinicians. DVRs of the trainings can be purchased.
• Professional Distance Learning courses
• Videos (Word)for additional education
• Programs (Word)that can come to hospitals and offer training
• Rationale for Physician Education (PDF)
• Courses for implementation of the     UNICEF Baby Friendly Initiative
• Section 1: Background and Implementation (PDF)
• Section 2: Strengthening and sustaining the Baby-Friendly Hospital Initiative: A Course for Decision-Makers (PDF)
• SECTIION 3: (replaces the previous “18 Hour Course”)
•  3.1 Guidelines for Course Facilitators including a Course Planning Checklist (PDF)
•  3.2 Outlines of Course Sessions (PDF, 1.4MB)
•  3.3 PowerPoint Slides for the Course (PPT, 2.6MB)

1.6 Hospitals should demonstrate support for breastfeeding by fostering the formation of breastfeeding support groups.

1.6.1 Hospital administration should provide space and/or cover operational costs to support local community lactation support groups or hospital-based breastfeeding support groups.

1.6. Ongoing peer support groups lead to increased success and increased duration of breastfeeding. 15,16,18,23 (note policy #10).

• Peer Counselors for Breastfeeding Mothers in the Hospital Setting: Trials, Training, Tributes, and Tribulations (Abstract)
• Bibliography on the value of support groups
• WIC Breastfeeding Peer Counselor Training Manual

1.7 Hospitals, as employers, should demonstrate support for breastfeeding employees by providing education and assistance to pregnant and lactating staff. Employers should provide a clean, comfortable break space and time to express milk for hospital staff who are breastfeeding mothers and should consider offering

1.7.1 electric breast pumps for hospital staff use.

1.7.2 extended maternity or paternity leave.

1.7.3 on-site child-care for breastfeeding infants of hospital staff.

1.7.4 private space and time for the mother to nurse her baby during breaks.

1.7 Workplace environments that support breastfeeding facilitate continuation of breastfeeding. 20,21,23,25

1.7.4 California state law requires employers to provide a private space other than a toilet stall and a reasonable amount of unpaid time (if it is not concurrent with usual break time) for breastfeeding mothers to express milk. 14

• Employed/Working Mothers’ Breastfeeding Resources