Breastfeeding in the First Hour of Life: Translating Research into Practice Using Quality Improvement

Purpose:
The QI initiative addressed improving staff compliance with our breastfeeding policy and documentation. Our goal was to achieve the Baby Friendly Hospital Initiative (BFHI) standard that 80% of vaginal births and 60% of c/s births would be assisted with breastfeeding in the first hour of life.

Significance:
Early initiation of breastfeeding positively impacts breastfeeding exclusivity and duration. The benefits of exclusive breastfeeding for baby, mom, and community are numerous and well documented. Meeting the BFHI goals are required to become a Baby Friendly Hospital, our facility's goal.

Strategy and Implementation:
An ongoing monthly QI initiative was implemented in March 2009 to track our progress, provide feedback, and promote compliance with BFHI standards. An audit team of nurses was established to create and implement the QI initiative. Every birth during the calendar month was reviewed in the electronic medical record. Only term, healthy infants and mothers were considered for audit. If the birth met all qualifying factors, birth time and time to breast were noted. The total infants to breast in the first hour of life divided by the total qualifying births determined the monthly percentage. The QI audit continued monthly in this way for a year, at which point it was well established that our practice and documentation goals were consistently being met. In March 2010 the auditors began analyzing every third vaginal delivery and every third cesarean delivery for inclusion in the audit. Data continues to be gathered monthly using this population.

Evaluation:
In 3/09 62% of vaginal and 23% of c/s births nursed in the first hour. By 8/09 we beat our goal: 95% of vaginal and 75% of cesarean births. We continue to exceed our goal monthly. In 2010 we became NC's first Baby Friendly Hospital. The 86 th hospital in the nation to earn this prestigious title.

Implications for Practice:
Rigorous, consistent QI initiatives have the power to prompt and maintain practice change. QI initiatives are excellent tools to motivate staff to embrace Evidence Based Care practices and to ensure that documentation matches actual practice.