Board #251 - Program Innovation Experiential Learning at it’s Breast

Abstract

Objectives The Center for Disease Control (CDC 2011) found <4% of U.S. hospitals provide a full range of support mothers need to be able to breastfeed. The hospital experience can have a strong influence on the mothers’ infant-feeding decisions by implementing practices in labor, delivery, and postpartum care, as well as in hospital discharge planning. As one of 89 facilities participating in NICHQ Best Fed Beginnings Learning Collaborative to improve practices that support breastfeeding, an interdisciplinary team developed an innovative clinical skills education and competency program using high-fidelity simulation, standardized patient interactive scenarios and skills labs to enhance and verify nursing competency in the 4 Baby Friendly Skills Competencies for Maternity Staff: 1) Communicating with pregnant and postpartum women about infant feeding; 2) Observing, assessing, and assisting with breastfeeding; 3) Teaching hand expression and safe storage of milk; and 4) Teaching safe formula preparation and feeding. Additional topics included changing habits of providing formula supplementation beyond medical need, changing reliance on a nursery and shifting care to 24-hour rooming-in, and altering staff responses to feeding challenges. Description A total of 240 RNs and 48 ancillary nursing staff were trained using a ‘bolus approach’ with 37 sessions held over an eight day period. The training included: 1) A skills lab which had reviewed policies, held, open discussion, informational videos (e.g. Stanford breast expression video), breast hand expression task trainer model, hospital equipment (e.g. breast pump), and educational materials (e.g. formula safety and patient education poster), and peer staff surveys; and 2) Scenarios which used standardized patients for a more realistic learning environment. The skills station included a breast milk hand expression trainer (worn by the standardized patient) and allowed staff to practice positioning using a low-fidelity infant simulator, and practice techniques for hand expression of breast milk. The breast model was realistic in shape, texture and warm to the touch and mimics the normal female allowed learners to practice different ways for hand expression of milk and safe milk storage. The life-like breast was able to excrete milk (i.e. formula). The hand expression mimics natural stimulation of breast milk during feeding. RNs were also able to then practice techniques for collecting milk. CME application was submitted and nurses were awarded contact hours. Conclusion Data was collected and analyzed for pre-/post-assessment and evaluations for training, on–unit patient audits, and lactation consultant feedback. Results indicated an improvement in key areas targeted in the training. Significant improvements (p=.000) were seen in RNs ability to: correctly identify frequency mothers should express milk, how to teach hand expression, and reasons to avoid supplements unless medically indicated. The number of RNs increased by 28% that reported teaching BF patients hand expression. Additionally, RNs reported increased confidence to: 1) communicate with patients about infant feeding, 2) observe, assess, and assist with BF, 3) demonstrate teaching, hand expression, use of breast pumps and safe storage of milk, 4) teach safe formula preparation and feeding. Interestingly, areas of significant improvement were areas highlighted in simulation and scenarios in training, particularly using the hand expression breast model. Supporting evidence of impact is provided by medical record data received immediately after training reporting the highest exclusive BF rate recorded- 81% and lowest on record 19% BF babies supplemented with formula. Patient audits support findings, indicating baby-friendly practices are being used.