The Baby Friendly Hospital Initiative IHS Clinical Rounds July - - PowerPoint PPT Presentation

▶
the baby friendly hospital initiative ihs clinical rounds
SMART_READER_LITE
LIVE PREVIEW

The Baby Friendly Hospital Initiative IHS Clinical Rounds July - - PowerPoint PPT Presentation

Jul 16, 2023 142 likes •733 views

The Baby Friendly Hospital Initiative IHS Clinical Rounds July 12th, 2012 Host: Susan Karol, MD; IHS Chief Medical Officer Presenter: - Suzan Murphy, MPH, RD, CDE, IBCLC Objectives for Todays Rounds Enumerate the public health

slide-1
SLIDE 1
  • Host:

Susan Karol, MD; IHS Chief Medical Officer

  • Presenter:
  • Suzan Murphy, MPH, RD, CDE, IBCLC

IHS Clinical Rounds

July 12th, 2012

The Baby Friendly Hospital Initiative

slide-2
SLIDE 2

Objectives for Today’s Rounds

  • Enumerate the public health concerns addressed by supporting

breastfeeding.

  • Understand breastfeeding support outcomes that the Baby Friendly Hospital

Initiative (BFHI) will improve.

  • Enumerate the ten steps to BFHI certification.
  • Demonstrate the importance of having at least one resource for

breastfeeding support and one for BFHI information.

slide-3
SLIDE 3

Accreditation

  • The Indian Health Service (IHS) Clinical Support Center is

accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The IHS Clinical Support Center designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • The Indian Health Service Clinical Support Center is accredited as a

provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

  • This activity is designated 1.0 contact hours for nurses.
slide-4
SLIDE 4

Accreditation applies solely to this educational activity and does not imply approval or endorsement of any commercial product, services or processes by the CSC, IHS, the federal government, or the accrediting bodies.

Disclaimer

slide-5
SLIDE 5

Guidelines for Receiving Continuing Education Credit

  • To receive a certificate of continuing education or certificate of

attendance, you must attend the educational event in its entirety and successfully complete an on-line evaluation of the seminar within 15 days of the activity. At the end of the evaluation, click on the appropriate line to obtain your certificate, fill in your name and print the certificate.

  • If you need assistance, please contact Dr. Chris Fore (chris.fore@

ihs.gov) or Mollie Ayala (mollie.ayala@ihs.gov).

slide-6
SLIDE 6

Faculty Disclosure Statement

  • As a provider accredited by ACCME, ANCC, and ACPE, the IHS

Clinical Support Center must ensure balance, independence,

  • bjectivity, and scientific rigor in its educational activities. Course

directors/coordinators, planning committee members, faculty, and all

  • thers who are in a position to control the content of this educational

activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be included in course materials so those participating in the activity may formulate their own judgments regarding the presentations. The course directors/coordinators, planning committee members, and faculty for this activity have completed the disclosure process and have indicated that they do not have any significant financial relationships

  • r affiliations with any manufacturers or commercial products to

disclose.

slide-7
SLIDE 7

Topics for Future Rounds

August 9, 2012: “Standards of Care and Clinical Practice Recommendations: Type 2 Diabetes” Ann Bullock, MD; Cherokee Hospital Sept 13, 2012: “Improving Timing Stroke Care: Advances in Tele-Stroke Consultation”

  • Dr. Bart Demaerschalk; Mayo Clinic
slide-8
SLIDE 8

Meet the Presenter

Suzan Murphy Sue Murphy has been a public health nutritionist since 1976, has served in IHS since 1994. She has worked in breastfeeding support at PIMC since 1999.

  • Ms. Murphy holds a Masters in Public

Health from the University of California, Berkeley, is a Registered Dietitian, a Certified Diabetes Educator, and is certified by the International Board

  • f Lactation Consultants.
slide-9
SLIDE 9

Supporting Breastfeeding

US Department of Health and Human Services Indian Health Service Adobe Connect meeting July 12, 2012

slide-10
SLIDE 10

Thank you for joining us today

My name is Sue Murphy I am an RD, MPH, CDE, IBCLC

Phoenix Indian Medical Center 4212 N 16th Street Phoenix, AZ 85016 602-263-1200 X 1737 Breastfeeding Helpline – 1-877-868-9473 suzan.murphy@ihs.gov

slide-11
SLIDE 11

Learning Objectives

Participants will be able to identify:

  • 1. Public health concerns addressed by supporting

breastfeeding.

  • 2. Breastfeeding support outcomes that the Baby Friendly

Hospital Initiative (BFHI) will improve.

  • 3. The ten steps to BFHI certification.
  • 4. At least one resource for breastfeeding support and one for

BFHI information.

slide-12
SLIDE 12

IHS and Tribal Health Care (www.ihs.gov)

slide-13
SLIDE 13

Healthy children are the goal of every community and the future of each tribe

slide-14
SLIDE 14

Prevalence of Overweight and Obesity in IHS Active Clinic Patients (2008)

81% 51% 49% 45%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

20-74 yrs 12-19 yrs 6 - 11 yrs 2-5 yrs

slide-15
SLIDE 15

Prevalence of Type 2 Diabetes and Pre-Diabetes

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% AI/AN AI/AN pre-diabetic non-Hispanic white

30%

estimate

8.7%

HHS/IHS/Division of Diabetes Treatment and Prevention, Facts at-a-Glance, June 2008

16.3 %

slide-16
SLIDE 16

Obesity Rates in the General Population, CDC 2010 Obese = >30 BMI

17.0% 33.8% 0% 5% 10% 15% 20% 25% 30% 35% 40%

2-19 yrs adults

Obesity and Diabetes are Epidemic

slide-17
SLIDE 17

Perinatal and Lifelong Impact

Perinatal predictors of future risk for diabetes and over weight:

  • Gestational diabetes/impaired glucose tolerance.
  • Macrosomia/newborn hypoglycemia.

CDC, 2011 –

  • New diagnostic criteria for gestational diabetes will increase the

proportion of women diagnosed with gestational diabetes.

  • Using these new diagnostic criteria, an international, multicenter

study of gestational diabetes found that 18% of the pregnancies were affected by gestational diabetes.

slide-18
SLIDE 18

Relative weight (%) Rate of diabetes (%)

Type 2 Diabetes at age 40 by Early Feeding Choice (1997)

slide-19
SLIDE 19

More Results (Young et al, 2002)

1 0.24

0.2 0.4 0.6 0.8 1 1.2

Formula Fed Breastfed 12 months or longer

  • dds ratio

Early Infancy Risk Factors for Diabetes in Native Canadians

slide-20
SLIDE 20

Risk of Early Childhood Overweight for Infants of Gestational Pregnancy

(Schaefer-Graf UM et al, 2006)

33.7% 32.5% 22.0%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Not breastfed Breastfed less than 3 months Breastfed more than 3 months

n = 354

slide-21
SLIDE 21

Obesity Risk by Feeding Choice at Nine Months (T Harder et al, 2005)

slide-22
SLIDE 22

SIDS

0.64 1 0.2 0.4 0.6 0.8 1 1.2 Any Breastfeeding Formula

  • dds ratio

SIDS by Feeding Choice at 6 months (M Bartick et al, 2010) 75% of SIDS occurs between 2 - 6 months of age

slide-23
SLIDE 23

And for Mom

Less risk of:

  • Type 2 Diabetes
  • Ovarian Cancer
  • Breast Cancer
slide-24
SLIDE 24

Health $ Saved in Billions

(M Bartick et al 2010)

$3.35 $2.68

$0.00 $1.00 $2.00 $3.00 $4.00 90% Breastfeeding rate 80% breastfeeding rate Billions

Percentage of new families reaching Healthy People 2010 goals – Exclusive breastfeeding to 6 months, Continued breastfeeding with solids to 1 yr or more.

slide-25
SLIDE 25

Socioeconomic Benefits

  • Breastfed infants usually require fewer sick care visits,

prescriptions, and hospitalizations.

  • Employers benefit: improved absenteeism rates.
  • Reduced insurance costs.
slide-26
SLIDE 26

Lives Saved Annually

(M Bartick et al 2010)

400 741 911

100 200 300 400 500 600 700 800 900 1000 90% 80% carseats (DOT data)

Percentage of new families reaching Healthy People 2010 goals – Exclusive breastfeeding to 6 months, Continued breastfeeding with solids to 1 yr or more.

slide-27
SLIDE 27

More Breastfeeding Means

  • Less illness for babies and their communities.
  • Less diabetes for baby and mom.
  • Less obesity or overweight.
  • Fewer health care dollars used

for preventable problems.

slide-28
SLIDE 28

Baby Friendly Hospital Initiative (BFHI/USA)

  • BFHI - part of Let’s Move! in Indian Country (LMIC):
  • LMIC is the White House initiative to reduce obesity among

children.

  • Reflected in the new IHS Healthy Weight for Life Initiative
  • BFHI will bring new awareness to the untapped benefits of

breastfeeding.

slide-29
SLIDE 29

What does Baby Friendly mean?

  • 1. Have a written breastfeeding policy that is routinely

communicated to all health care staff.

  • 2. Train all health care staff in skills necessary to implement

this policy.

  • 3. Inform all pregnant women about the benefits and

management of breastfeeding.

  • 4. Help mothers initiate breastfeeding within one half-hour
  • f birth.
  • 5. Show mothers how to breastfeed and maintain lactation,

even if they should be separated from their infants.

slide-30
SLIDE 30

What does Baby Friendly mean? (cont)

  • 6. Give newborn infants no food or drink other than breast

milk, unless medically indicated.

  • 7. Practice rooming in - that is, allow mothers and infants

to remain together 24 hours a day.

  • 8. Encourage breastfeeding on demand.
  • 9. Give no artificial teats or pacifiers (also called dummies
  • r soothers) to breastfeeding infants.
  • 10. Foster the establishment of breastfeeding support

groups and refer mothers to them on discharge from the hospital or clinic.

slide-31
SLIDE 31

As of 2007, in the US

  • 2.9 percent live births occurred in facilities that

provide recommended care for lactating mothers and their babies

slide-32
SLIDE 32

BFHI Results

BFHI (US) No BFHI Initiation 84% 70% Exclusivity 78% 46%

Pediatrics, Merewood A, et al, 2005

slide-33
SLIDE 33

Duration

(DiGirolamo AM et al, 2008)

If:

Six BFHI steps experienced

  • 1. Bf initiation within one hour
  • 2. Bf only
  • 3. Rooming in
  • 4. Bf on demand
  • 5. No pacifiers
  • 6. Bf support groups
slide-34
SLIDE 34

Then, at Six weeks:

Families were 13 times more likely to still be breastfeeding…

…compared to families who didn’t experience any of the steps.

slide-35
SLIDE 35

Risk of Breastfeeding Cessation Before Six Weeks by Number of BFHI Steps Experienced

(DiGirolamo et al., 2008)

30.0% 26.9% 21.5% 15.5% 13.7% 6.2% 3.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

1 2 3 4 5 6 7

0 steps 1 step 2 steps 3 steps 4 steps 5 steps 6 steps

Reproduced with permission, Best Fed Beginnings: An Introduction to the NICHQ and the CDC Breastfeeding Initiative January 2012 Seminar

slide-36
SLIDE 36

Continuation of Breastfeeding to Eight Weeks by Hospital Experience

(Murray, et al. 2007)

Reproduced with permission, Best Fed Beginnings: An Introduction to the NICHQ and the CDC Breastfeeding Initiative January 2012 Seminar

77% 81% 74% 78% 75% 66% 65% 62% 69% 64% Breastfeeding in the first hour No supplemented feeding Rooming In No pacifiers Phone number given to mother no yes

slide-37
SLIDE 37

Colorado Can Do 5

Marilyn Neifert, MD “Dr Mom” Program where Colorado hospitals adopt 5 of the 10 BFHI steps – Results:

  • Medicaid families
  • All five steps 78% breastfeeding at 4 months
  • None of steps 61% breastfeeding at 4 months
  • 17% increase in duration
slide-38
SLIDE 38

PIMC Crib Card Steps

Five Steps for Breastfeeding Success: 1.At Birth – Hold your baby, skin-to-skin on your chest. Your closeness helps your baby begin learning how to breastfeed. 2.Stay together - Keep your baby in your room, near you. The early time of practicing breastfeeding together is important. 3.Breastfeed – Just like your ancestors’ milk, your milk has everything your baby needs. When your baby nurses, your body begins the ancient path to make mother’s milk. If your baby gets formula early, it can interfere with nature’s delicate balance. When you breastfeed 8 times or more in 24 hours, you and your baby make breastfeeding work. 4.Only you – Breastfeeding will get easier soon. Plastic nipples can confuse your baby and your milk supply. When you avoid pacifiers and bottles in the first month, your baby is more likely to breastfeed longer. 5.Support - Questions? Call WIC Peer Counselors – 602-319-1588, PIMC Helpline - 877-868-9473, or AZ Hotline - 800-833-4642.

This card is made possible by the generous collaboration of the Colorado Department Public Health & Environment’s Can Do 5! Program

  • W. Daychild
slide-39
SLIDE 39

Example from CDC.gov

slide-40
SLIDE 40
slide-41
SLIDE 41

 Baby-Friendly USA 2010

For more information go to www.babyfriendlyusa.org

slide-42
SLIDE 42

What is happening in PIMC now?

BFHI Each BFHI step has requirements for example, Step One Policy, has 8 requirements To keep our ducks lined up, we use an Excel spreadsheet

slide-43
SLIDE 43

Electronic Health Records RPMS searches

Infant feeding tool can be used in either system Tool tracks feeding choice with date of visit. Results for exclusively and mostly breastfeeding are part of a quarterly report – check with your IT/CAC

slide-44
SLIDE 44

Infant Feeding Tool

slide-45
SLIDE 45

Future Education Ideas

  • OB/Nursery staff – on line training
  • Hospital/clinic staff – netlearning
  • Community – Outreach, health fairs, and posters that describe the

new policy in user-friendly language

slide-46
SLIDE 46

Where are we now?

  • Skin to skin has made a difference
  • Increasing initiation from ~ 75% to ~85%
  • Classes – WIC/Childbirth
  • Lactation alerts in EHR
  • Community participation – Faith based groups
  • Pediatrics staff – champions of data collection
slide-47
SLIDE 47

WIC Peer Counselors

  • Daily rounds
  • Enroll new families
  • Provide support as peers
  • Some can provide electric pumps
  • They have made a difference at PIMC
slide-48
SLIDE 48

One Change can Make a Difference

  • Use what works, talk with your team.
  • Even if it is only yourself.
  • Nudging one idea will begin change.
slide-49
SLIDE 49

Remember to breathe

slide-50
SLIDE 50

Hope for the Future

Begins with knowing about breastfeeding

slide-51
SLIDE 51

Honoring the Choice

slide-52
SLIDE 52

Supporting the Choice

Fort Defiance, Employee Pump Room Navajo Nation, AZ

slide-53
SLIDE 53

Valuing the Tradition of Mother’s Milk

slide-54
SLIDE 54

Fort Defiance Breastfeeding Walk - 2010

Celebrating the Choice

slide-55
SLIDE 55

Already, Employee Breastfeeding Accommodation

Chinle Pump Room Grand Opening

Navajo Nation Breastfeeding Coalition and Health Resources and Services Administration

slide-56
SLIDE 56

AI/AN Communities are Ready

  • AI/AN traditional cultures honor the mother and her role
  • AI/AN cultures have always supported breastfeeding
  • Family members are key resources to the mother
  • Breastfeeding supports nurturing and

bonding

slide-57
SLIDE 57

Thank you for being part of this Webex

  • www.ihs.gov - Go to:
  • Breastfeeding
  • IHS diabetes best practices
  • Breastfeeding Listserv (please email me)
  • Office of Women’s Health
  • Lactmed - current, NIH/NLM source for medicine and breastmilk
  • Local WIC and regional WIC
slide-58
SLIDE 58

More Resources

  • Baby Friendly Hospital Initiative
  • BFHI/USA
  • WHO and UNICEF – international Baby Friendly
  • United States Breastfeeding Committee (USBC)
  • Academy of Breastfeeding Medicine - reliable source for clinically based

protocols