Development and Implementation of a Perinatal Nursing Sensitive Indicator: Breastfeeding in the Delivery Room

Purpose:
This performance indicator was developed to measure initiation of breastfeeding and “skin to skin” contact in the immediate postpartum period. The goal was to optimize lactation outcomes by providing all breastfeeding dyads with the opportunity to experience a successful latch in the delivery room.

Significance:
Breast milk is the optimal source of nutrition for infants with proven health benefits. Breastfeeding in the immediate postpartum period is a nursing driven evidence based practice associated with successful lactation. Nursing support and expertise in the delivery room is crucial to this process.

Strategy and Implementation:
The labor and delivery staff has developed several process improvements aimed at promoting breastfeeding in the delivery room. It is an ideal nursing sensitive indicator for this specialty area. The chosen methodology for performance measurement was monthly chart reviews. An audit tool was developed to provide consistency in data collection. Inclusion criteria were “intent to breastfeed” on admission and infant “present” with mother in the recovery period. Performance outcome criteria included an attempt to latch or provision of “skin to skin” contact. We chose 75 % as a target in line with the Healthy People 2010 goal. Initial audits revealed the need to revise breastfeeding documentation from a “free text” option to a more structured flow sheet. This served as a reminder for staff less focused on breastfeeding as an essential component of the transition period and allowed more concise data collection. Staff received reports monthly as well as individualized performance feedback.

Evaluation:
Initiation of breastfeeding in the delivery room has increased since we began data collection and providing feedback. In the first quarter of 2009 34% of patients sampled had breastfed or provided skin to skin contact in the delivery room. By the second quarter of 2011 the rate increased to 76%.

Implications for Practice:
As well as improving breastfeeding rates in the delivery room, this initiative has raised awareness of the importance of using data to drive performance improvement. We have registered our intent to become a “Baby Friendly” hospital, a process that will guide and continue to improve our practice.