Baby-Friendly USA, Inc. (BFUSA) - California Breastfeeding Coalition

Disclosure
• The speaker discloses employment with
Baby-Friendly USA, Inc. (BFUSA)
• There are no other conflicts of interest
• This presentation is not supported by any
funds from companies that violate the
International Code of Marketing of
Breastmilk Substitutes
Objectives
By the end of the presentation,
participants should be able to:
• Describe the importance of the external
verification process in assuring that the Ten
Steps to Successful Breastfeeding are solidly
incorporated into the maternity care practices
at their facility
Objectives
By the end of the presentation,
participants should be able to:
• Utilize the information to convene a multidisciplinary team and develop plans to move
forward with achieving the Baby-Friendly
designation in their facility
• Describe the costs associated with achieving
Baby-Friendly designation
Congratulations
California passed SB 402 which
requires all hospitals by January 1,
2025:
• To achieve the Baby-Friendly designation,
• An alternate process adopted by a health care
service plan that includes evidenced-based
policies and practices and targeted outcomes
•
Or the Model Hospital Policy
Importance of
Accreditation
The Baby-Friendly Hospital Initiative is an
accreditation program
1: to give official authorization to or
approval of:
a : to provide with credentials;
b : to recognize or vouch for as conforming
with a standard
2: to consider or recognize as outstanding
http://www.merriam-webster.com/dictionary/accreditation
What is Accreditation?
Accreditation is
• the status awarded to people or
organizations
• that have undergone and satisfied a
rigorous process of assessment
• by an independent body
http://articles.pubarticles.com/the-importance-of-accreditation-in-thehealth-care-system-1300895317,124682.html
Importance of
Accreditation
• It attests to the quality of care provided
by a facility
• It certifies that the facility meets the
Accreditor's brand and standard of
service
http://articles.pubarticles.com/the-importance-of-accreditation-in-thehealth-care-system-1300895317,124682.html
Importance of
Accreditation
• Accreditation is a seal of approval
from an independent body that can
build patient confidence in the
institution
• ACCREDITATION IS MARKETABLE
http://articles.pubarticles.com/the-importance-of-accreditation-in-thehealth-care-system-1300895317,124682.html
Answering the Call
Claim Leadership Role in Answering the
Nation’s Call:
•
•
•
•
Healthy People 2020 goals for breastfeeding
Improving the CDC m-PINC scores
Surgeon General’s Call to Action to Support BF
National Prevention Strategy for Health &
Wellness
• Institute of Medicine – Obesity Prevention
Policies
Top 10 Hospital
Benefits
# 10 - Elevate the facility
reputation by receiving a
globally prestigious
award
# 9 - Enhance the
environment of
competence among staff
# 8 - Enhance
leadership and team
skills among staff
Top 10 Hospital
Benefits
# 7 - Deliver
evidence-based,
patient-centered care
# 6 - Improve patient
satisfaction
# 5 - Improve health
outcomes for mothers
and babies
Top 10 Hospital
Benefits
# 4 - Demonstrate a
commitment to
quality improvement
# 3 - Meet corporate
compliance
requirements
# 2 - Meet Joint
Commission perinatal
core measures for
exclusive breast milk
feeding
Top 10 Hospital
Benefits
# 1 - Babies
are born to
be breastfed
Fundamental
BFHI Principles
• Well-constructed comprehensive
policies effectively guide staff to deliver
evidence based care
• Well trained staff provide state of the
art, evidenced based care
• Monitoring of practice is required to
assure adherence to policy and
evidence
Evidence for
Baby-Friendly
http://www.who.int/nutrition/publications/evidence_ten_step_eng.pdf
Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681
Evidence for
Baby-Friendly
Baby-Friendly Hospital Initiative Improves
Breastfeeding Initiation Rates in a US Hospital Setting
RESULTS: The breastfeeding initiation rate increased from 58% (1995) to
77.5% (1998) to 86.5% (1999)
CONCLUSION: Full implementation of the Ten Steps to Successful
Breastfeeding leading to Baby-Friendly designation is an effective
strategy to increase breastfeeding initiation rates in the US hospital
setting
Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding
Initiation Rates in a US Hospital Setting. Pediatrics 108(3):677-681
BFHI Compared to State Program
http://texastenstep.org/starachiever-texastenstep/index.html
BFHI Compared to State Program
http://texastenstep.org/starachiever-texastenstep/index.html
Evidence for
Baby-Friendly
Baby-Friendly Hospital Accreditation, InHospital Care Practices, and Breastfeeding
When breastfeeding-initiation rates are high and
evidence-based practices that support breastfeeding
are common within the hospital environment, BFHI
accreditation per se has little effect on both exclusive
or any breastfeeding rates.
Brodribb W et al. 2013 Baby-Friendly hospital accreditation, in-hospital
care practices, and breastfeeding. Pediatrics. Apr; 1 31 (4):685-92
2012/2013
Re-Designation Results
In 2012, BFUSA strengthened the ReDesignation process
2012/2013 Re-Designating hospitals were
grouped together
Facilities were required to audit all Ten Steps
utilizing tools provided by BFUSA
Audit results submitted to BFUSA –
Preliminary results were due October 15, 2012
Final results were due October 15, 2013
2012/2013
Re-Designation Results
Policy-Step 1
2012
All 37 hospitals submitted policies that lacked
required components identified on our policy
check-off tool
BFUSA reviewed all 37 policies on multiple
occasions
2013
28 Passed on Policy
9 Still need work in order to pass
2012/2013
Re-Designation Results
Audit Results
2012
2013
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
Step 9
Step 10
11 Passed
12 Passed
29 Passed
19 Passed
21 Passed
32 Passed
33 Passed
16 Passed
32 Passed
30 Passed
28 Passed
36 Passed
34 Passed
35 Passed
All Passed
All Passed
32 Passed
All Passed
Code
28 Passed
30 Passed
2012/2013
Re-Designation Results
18 facilities were
Re-Designated
19 facilities were given the status of
RE-Designated Pending
We saw that ongoing data collection and
performance review (audits) are necessary to
maintain evidence based practice to support
breastfeeding
In the absence of on-going monitoring, practices
backslide
Cost of Baby-Friendly
Designation
Every facility has different challenges and different
costs associated with those challenges
Primary costs are:
1. Fees to BFUSA
2. Cost of staff training
3. Cost of purchasing breast milk substitutes,
bottles and nipples
The
Pathway to
Baby-Friendly Designation
Dissemination
Collect Data
Baby-Friendly
Designation
Designation
Bridge to
Designation Phase
Dissemination
Certificate of Completion
Implement
QI Plan
Readiness
Interview
On-Site
Assessment
Train Staff
Bridge to
Dissemination
PhaseDevelopmentCertificate of
Completion
Data
Collection
Plan
Staff Training
Plan
Prenatal/Postpartum
Teaching Plans
Development
Start
Discovery
Register with
Baby-Friendly USA
Obtain CEO
Support Letter
Complete Self
Appraisal Tool
© 2012 Baby-Friendly USA, Inc..
Bridge to
Development PhaseRegistry of Intent
Award
Hospital
Breastfeeding
Policy
BFHI
Work Plan
BF Committee
Or Task Force
Fees to
Baby-Friendly USA, Inc.
Fee schedule is found at:
http://www.babyfriendlyusa.org/get-started/4dfee-schedule
Discovery Phase is free
All other phases have an associated fee
Fees are good for either the phase or 1 year,
which ever comes first
Designated facilities pay an annual fee
BFUSA Fees Support
All BFUSA operations
Development and maintenance of all tools
and materials
Staff support for each phase
Website and portal
BFUSA does not receive funds from
WHO/UNICEF
BFUSA Fees Support
DEVELOPMENT PHASE MATERIALS
Guidelines and Evaluation Criteria
Model Action Plans
Budget planner
Policy development tool
Policy check off tool
Community survey
Patient education planning template
BFUSA Fees Support
Staff training planning template
Staff education documentation tool
Data Collection planning template
BFHI power point presentation
BFUSA Fees Support
DISSEMINATION PHASE MATERIALS
Audit tools
Code implementation
Policy implementation
Staff competency
Staff knowledge
Training implementation
Patient knowledge
Infant Feeding Outcomes
BFUSA Fees Support
DESIGNATION PHASE MATERIALS
Readiness Assessment Telephone
Interview
Attestation of Purchasing of Breast Milk
Substitutes, Bottles and Nipples
BFUSA support in planning for on-site
assessment
BFUSA Fees Support
RE-DESIGNATION/ QI MATERIALS
Audit Tools
Attestation of Purchasing of Breast Milk
Substitutes, Bottles and Nipples
Cost of Breast Milk
Substitutes
Improve exclusive breastfeeding rates
Adopt “in-facility use only” policy for breast milk
substitutes
Audit actual usage of breast milk substitutes
specifically in the facility
Consider putting breast milk substitutes in
medication carts/dispensing units requiring staff
signature for utilization
Cost of Breast Milk
Substitutes
Evaluate “expiration date” policy for
products and determine its adequacy
for breast milk substitutes
Educate receiving room staff
responsible for receiving products on
“expiration date” policy for breast milk
substitutes
Cost of Training
Identify competent “in-house” trainer
Identify competent community trainer
Attend train the trainer program
On-line training
Consider applying for grants
Cost of Training
Partner with other organizations to share
costs:
•
•
•
Hospitals
WIC
Community programs
Programs offered by a training company
Self contained learning modules
Cost of Baby-Friendly
Designation
Cost Comparison of Baby Friendly and
Non–Baby Friendly Hospitals in the United
States
Becoming Baby-Friendly is relatively cost-neutral
for a typical acute care hospital. Although the
overall expense of providing Baby-Friendly
hospital nursery services is greater than nursery
service costs of non–Baby-Friendly hospitals, the
cost difference was not statistically significant.
DelliFraine, J., et.al. Cost Comparison of Baby Friendly and Non–Baby Friendly
Hospitals in the United States, Pediatrics 2011;127:e989–e994