Term Paper on "Achieving Baby Friendly Hospital Designation"

Term Paper 10 pages (2900 words) Sources: 10

[EXCERPT] . . . .

Achieving Baby-Friendly Hospital Designation

Baby-Friendly Hospital Designation

Achieving Baby-Friendly Hospital Designation: Brookdale University

Hospital & Medical Center

Fiscal Management of Health care organizations

Dr. Carouselli

The purpose of this project is to work towards Baby-Friendly Hospital Designation (MacEnroe, 2010) (Merewood, & Philipp, 2001)for a hospital in Brownsville section of Brooklyn, namely Brookdale University Hospital and Medical Center. There are many reasons for pursuit of this designation, it is both prestigious and working towards it may improve this hospital's practices as it relates to evidence-based maternity care regarding breastfeeding and maternal and infant health. The Baby-Friendly Hospital Designation ultimately will save lives, as the practices and policies associated with it will improve breastfeeding rates among new moms and improve infant health and maternal health and welfare in both the short- and long-term. Brookdale Hospital is an academic teaching Hospital serving primarily minority, poor, and immigrant families and is located in Brownsville/East New York Section of Brooklyn. In Brownsville, 11 infants died out of every 1,000 live births from 2007 to 2009, twice the city rate and closely followed by East New York and Bedford Stuyvesant sections of Brooklyn according to the New York City Department of Health and Mental Hygiene (NYCDOHMH, 2010). Brookdale Hospital serves primarily minorities, poor, and immigrant families. Breastfeeding is not supported in this population at Brookdale due to practice protocol, institutional standards and ethnic and other social reasons.

Exclusive breastfeeding among women with infant ages from 0-3 and 0-6 months is clearly indicative of a reduction in infant mortality rates and health complications due to poor nutrition and decreased immune system function ("Breastfeeding-related maternity practices…" 2008). Breastfeeding promotes infant health even when maternal health is compromised for any number of reasons, including maternal cigarette smoking (Dorea, 2007), as well as being a mitigating factor in reducing later childhood obesity a growing problem in the U.S. And elsewhere which creates an extreme predisposition for obesity in adulthood a costly and again growing problem (Bainbridge, 2009, p. 393). Breastfeeding also clearly reduces rates among infants and children of several minor and major infectious diseases, that are costly to treat and can result in infant mortality. It is therefore extremely important to institute functional evidence-based changes to increase breastfeeding rates in the area and make changes in the hospital obtaining the Baby-friendly designation can make a big difference in the outcomes of increased maternal breastfeeding and therefore improved infant and maternal health.

The current maternity care practices in this hospital must be improved. Though this is a national trend ("Breastfeeding support falling short at U.S.…," 2008) i.e. poor breastfeeding practice and support in hospitals the ethnic and socioeconomic status of those served at this hospital constitutes an even more serious need for the implementation of Baby-Friendly Hospital Designation and the various stipulations of this implementation and success see 10 steps to achieve breastfeeding success Appendix 1. Breastfeeding, and specifically exclusive breastfeeding rates are extremely low at Brookdale, and some of the reasons for this are evident in policy and practice surrounding maternity care at the hospital. Clearly the policy and practice issues can be addressed to improve breastfeeding rates and to introduce both the practice and the importance of exclusive breastfeeding to the population with the hope doing so will mitigate ethnic and other social reasons for not breastfeeding as it has at other similar hospitals who have instituted change and sought the Baby-Friendly Hospital Designation.

Starting in the Brookdale delivery room babies are not routinely placed on mom's abdomen as stated in the Hospital's Breastfeeding policy, rooming in is not routinely encouraged and/or practiced. There is a separate Newborn Nursery on the maternity unit that is well used, where nurses rather than mothers care for newborns. The routine newborn screening tests are done in the Newborn Nursery whereas they could be done at the mom's bedside. Clearly shown in the literature and the breastfeeding support works is a tendency for any separation of infant from mother reduces the chance of early physical bonding and infant instincts to seek to suckle. Breastfeeding education is done in prenatal clinics but a lot of patients do not have regular prenatal care so it is very important to initiate education at the first encounter, in the hospital and continue consistently throughout the hospitalization and make appropriate referrals upon discharge to continue breastfeeding education and promote exclusive breastfeeding. The low rates of breastfeeding initiation at this hospital are partly also due to cultural ethnic issues, health concerns of the mother and other factors but improvement is not an unachievable goal and will have both short- and long-term cost saving and health restoring benefits. There is also no Certified Lactation Consultant position in the hospital which presents a great challenge, for early breastfeeding initiation, teaching and post-discharge follow up breastfeeding support. As a part of the rollout of the Baby-Friendly Hospital Designation policy and procedure changes a Certified Lactation consultant will be hired.

There are however several initiatives that are going on right now to improve the situation. New Breastfeeding policy was written and implemented based on the new World Health Organization (WHO) and United Nations International Children's Fund (UNICF) Joint Commission guidelines (MacEnroe, 2010). All nurses from L&D, Maternity and NICU are encouraged to attend the Department of Health sponsored Certified Lactation Counseling Course, it is a week long course at the end of which they are able to receive a formal certification. To this day 80% of all RNs in the department have attended this course. It is an excellent education course that enables participants to gain evidence-based knowledge about benefits of breastfeeding as well as teaching skills. Breastfeeding classes are being conducted three times a week in the maternal baby unit by the Nurses already certified for mothers currently admitted after delivery. The hospital also applied for the Breastfeeding Initiative Grant. The NYC Department of Health and Mental Hygiene has received a 2-year grant from the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC). The grant is funded by the American Recovery and Re-investment Act of 2009 and is part of the HHS "Communities Putting Prevention to Work Initiative," a comprehensive prevention and wellness initiative to improve physical activity and nutrition and reduce obesity. Prevention activities will use policy, systems and environmental changes at the community level to create healthy environments and help prevent obesity. Breastfeeding has been identified as an important component of childhood and therefore adult obesity prevention and the grant will help building on the previous work to increase breastfeeding duration and exclusive breastfeeding rates (Grummer-Strawb & Shealy, 2009; American Academy of Pediatrics, 2005).

The New York City Department of Health and Mental Hygiene's Bureau of Maternal, Infant and Reproductive Health (BMIRH) was seeking up to four (4) New York City hospitals that are working to improve their breastfeeding rates among well infants with no medical contraindications to receive a two (2) year grant see appendix 2. BMIRH will partner with the hospitals to institute policies, procedures, data collection and other activities to help them to improve breastfeeding exclusivity, duration and support. This will be a great help along with other activities to first of all improve maternity care and ultimately achieve the Baby-Friendly designation. Brookdale hospital has secured one of the four grants from this source.

Literature Review

Currently Brookdale has very low breastfeeding rates and also high rates of treatment for the many diseases and complications that are made worse by lack of breastfeeding. The short-term economic implications include demonstration of increased rates of exclusive breastfeeding, which is supported by the evidence of other institutions that have achieved Baby-Friendly Hospital Designation (Merewood & Phillip, 2001) (Naylor, 2010). With this designation, Brookdale stands to avert a great deal of short- and long-term costs of treating both infants and mothers who experience negative health outcomes due to lack of breastfeeding. Savings associated with the Baby-Friendly Hospital Designation may be difficult to track due in large part to the monumental difference breastfeeding seems to have in the health and wellness of both mother and child over a lifetime but Brookdale should begin to see changes in health outcomes of infants and mothers within the first year of the five-year process of achieving Baby-Friendly Hospital Designation, including reduced rate of infant infectious disease. Savings will multiply over time to support a healthier community and universal change in community understanding of the importance of breastfeeding as an optimal feeding option for infants supporting both infant short- and long-term health. The changes that may be seen right away with increased breastfeeding is a reduction of the number of infant patients seen in the Brookdale ER for non-life threatening and some life-threatening infant diseases that are more often associated with non-breastfed infants. According to the American Association of Pediatrics diseases that are reduced include; "bacterial meningitis, bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, and late-onset sepsis in preterm infants. In addition, postneonatal infant mortality rates in the United States are reduced by… READ MORE

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