Success with the High 5 Initiative through Patient and Family Engagement

Saturday, 7 November 2015

Elizabeth 'Libby' Rosen, PhD, BSN, RN, IBCLC
School of Nursing, Baker University School of Nursing, Stormont-Vail HealthCare Campus, Topeka, KS, USA

The “High 5 for Mom & Baby: Hospital care that supports breastfeeding” is an initiative supported by the United Methodist Health Ministry Fund. This Kansas organization modeled their program after similar state wide initiatives. Utilizing evidence-based practice, this initiative has been shared with over 70% of the delivering hospitals in the State of Kansas which account for 93.4% of the babies born in the state.  The five practices include: assuring immediate and sustained skin-to-skin contact between mother and baby after birth, giving newborn infants no food or drink other than breast milk unless medically indicated, practicing rooming-in, giving no pacifiers or artificial nipples to breastfeeding infants, and providing mothers options for breastfeeding support upon discharge.  These strategies are for medically stable term infants to improve initiation, duration, and exclusivity of breastfeeding.  Bartick and Reinhold (2010) stated that we could save lives and more than 13 billion dollars in health care related expenses if 90% of new families breastfed exclusively for the first 6 months of the infants life. Reducing barriers to successful breastfeeding in the hospital increases the duration and exclusivity of breastfeeding overall (AAP, 2012; DHHS, 2011). There are adapted practices that are applicable to the NIC and pediatric units and a handout to address those populations will be provided. A barrier to successful implementation identified early in the process was family education. To successfully implement these practices, patient and family understanding is essential.  Hospitals have identified and implemented strategies to meet this challenge, including handouts, texting programs, community wide education, television spots and billboards.  During hospital stays having "common questions" cards and scripts for staff to practice responses has improved consistent messaging with new parents. Having a follow up clinic that is open and free to the public after discharge has been essential to meeting the needs of new families having breastfeeding challenges. The High 5 for Mom and Baby task force guided the change process and assisted the team in dealing with provider resistance as they adapted usual routines to accommodate skin to skin in the first hour of life and rooming in. Clinics and outpatient offices also needed education to be equipped to explain to families about the program and to adapt visitation and goals for the hospital stay. Webinars sharing information on skin to skin during cesarean birth and vaginal birth have provided essential strategies to assist work flow. Other webinar topics have included rooming in and implementing quiet time for hospital maternity units.  Finally, through family-centered prenatal education, community-wide education and collaboration, in-hospital bedside patient education, and utilization of a Breastfeeding follow-up clinic, engagement of patients and families can be accomplished. Patient and their families will understand the importance of the High 5 practices to assist them in achieving their goals for breastfeeding and improving their infant and family’s health.
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