Page 10<strong>Breastfeeding</strong>: Best for Baby <str<strong>on</strong>g>and</str<strong>on</strong>g> MotherCHAPTER BREASTFEEDING ACTIVITIESCaliforniaThe California Perinatal Quality Care Collaborative (CPQCC)By Nancy E Wight MD, IBCLC, FABM, FAAPThe c<strong>on</strong>cept of collaborati<strong>on</strong> am<strong>on</strong>g instituti<strong>on</strong>s for the purpose of improving overall quality of care is a key comp<strong>on</strong>ent of successful <str<strong>on</strong>g>and</str<strong>on</strong>g>efficient change in health care. Dialogue between clinical units, as well as visits by a multidisciplinary team from <strong>on</strong>e unit to another, canprovide an exchange of ideas <str<strong>on</strong>g>and</str<strong>on</strong>g> soluti<strong>on</strong>s to clinical problems. Where evidence is inc<strong>on</strong>clusive, sharing ideas <str<strong>on</strong>g>and</str<strong>on</strong>g> approaches to practice canoffer incentives to seek answers to important questi<strong>on</strong>s through collaborative clinical research. 1Building <strong>on</strong> the existing VON (Verm<strong>on</strong>t-Oxford Network) framework, the California Associati<strong>on</strong> of Ne<strong>on</strong>atologists (CAN), in associati<strong>on</strong>with multiple public <str<strong>on</strong>g>and</str<strong>on</strong>g> private partners (Kaiser Permanente Health Care Plan, the David <str<strong>on</strong>g>and</str<strong>on</strong>g> Lucille Packard Foundati<strong>on</strong>, Pacific BusinessGroup <strong>on</strong> Health, CA Dept. Health <str<strong>on</strong>g>and</str<strong>on</strong>g> Human Services, CA Perinatal Secti<strong>on</strong> AAP, CA ACOG) developed the California Perinatal QualityCare Collaborative (CPQCC) to foster benchmark performance by all of the NICUs in California. The three arms if the CPQCC are theData Center, The Perinatal Quality Improvement Panel (PQIP) <str<strong>on</strong>g>and</str<strong>on</strong>g> the research unit. 1PQIP regi<strong>on</strong>al opini<strong>on</strong> leaders identify NICU care practices that have the potential for improvement, using as criteria the availability of indicatordata, dem<strong>on</strong>strated variability in current practice, <str<strong>on</strong>g>and</str<strong>on</strong>g> research evidence of the validity <str<strong>on</strong>g>and</str<strong>on</strong>g> impact <strong>on</strong> outcome of the recommended practices.Practice recommendati<strong>on</strong>s in a selected area of care are presented in a st<str<strong>on</strong>g>and</str<strong>on</strong>g>-al<strong>on</strong>e quality improvement “toolkit” <str<strong>on</strong>g>and</str<strong>on</strong>g> a multidisciplinaryquality improvement workshop designed to “jump-start” unit teams. Participants are sent exercises before the workshop that are designedto assess current practice <str<strong>on</strong>g>and</str<strong>on</strong>g> create “cognitive diss<strong>on</strong>ance” as a force for change.Quality improvement (QI) initiatives have targeted antenatal steroid use, surfactant use, c<strong>on</strong>sistent mechanical ventilati<strong>on</strong>, ab<str<strong>on</strong>g>and</str<strong>on</strong>g><strong>on</strong>ment ofpostnatal steroid use, <str<strong>on</strong>g>and</str<strong>on</strong>g> preventi<strong>on</strong> of nosocomial infecti<strong>on</strong>. In 2004, the QI initiatives are nutriti<strong>on</strong> support of the VLBW infant (specificallysupporting breastfeeding) <str<strong>on</strong>g>and</str<strong>on</strong>g> preventi<strong>on</strong> of early-<strong>on</strong>set sepsis.I had the privilege of working <strong>on</strong> “Nutriti<strong>on</strong>al Support of the Very Low Birth Weight Infant: Part I, which encompasses 19 best practice recommendati<strong>on</strong>sin 3 secti<strong>on</strong>s, with an extensive reference list <str<strong>on</strong>g>and</str<strong>on</strong>g> multiple, practical appendices. 2 The entire toolkit was designed to help theNICU care team assess current nutriti<strong>on</strong>al practices <str<strong>on</strong>g>and</str<strong>on</strong>g> outcomes, <str<strong>on</strong>g>and</str<strong>on</strong>g> to promote <str<strong>on</strong>g>and</str<strong>on</strong>g> support breastmilk for VLBW infants as part of optimalnutriti<strong>on</strong>al management. Part 2 (2005) will include best practices in parenteral <str<strong>on</strong>g>and</str<strong>on</strong>g> enteral nutriti<strong>on</strong>, plus additi<strong>on</strong>al attenti<strong>on</strong> to c<strong>on</strong>tinuedsupport for breastfeeding in the NICU <str<strong>on</strong>g>and</str<strong>on</strong>g> post-discharge. The Toolkit, Part 1 is currently available as a free download (~150 pages). 21. Wirtschafter DD, Powers RJ. Organizing regi<strong>on</strong>al perinatal quality improvement: global c<strong>on</strong>siderati<strong>on</strong>s <str<strong>on</strong>g>and</str<strong>on</strong>g> local implementati<strong>on</strong>.NeoReviews. 2004; 5(2):e50-592. CPQCC/PQIP: nutriti<strong>on</strong>al support of the very low birth weight infant: part 1, http://www.cpqcc.org/Nutriti<strong>on</strong>Toolkit.htmlFlorida Chapter ActivitiesBy Joan Meek, MD, FAAP, IBCLCFloridaArnold “Bud” Tanis, MD, <str<strong>on</strong>g>and</str<strong>on</strong>g> Joan Meek, MD, FAAP, IBCLC, c<strong>on</strong>tinue to serve as the Florida Chapter <strong>Breastfeeding</strong> Coordinators. Theywork closely with all of the Chapter <strong>Breastfeeding</strong> Coordinators <str<strong>on</strong>g>and</str<strong>on</strong>g> with the AAP Secti<strong>on</strong> <strong>on</strong> <strong>Breastfeeding</strong>, within the AAP Department ofCommunity Pediatrics, to support breastfeeding.[c<strong>on</strong>tinued <strong>on</strong> p 11]
Page 11<strong>Breastfeeding</strong>: Best for Baby <str<strong>on</strong>g>and</str<strong>on</strong>g> MotherCHAPTER BREASTFEEDING ACTIVITIES [CONTINUED FROM P 10]Florida [c<strong>on</strong>tinued]The 9th annual Internati<strong>on</strong>al Academy of <strong>Breastfeeding</strong> Medicine meeting, “Hot Topics in <strong>Breastfeeding</strong>: Celebrating the Year of the Family,”will be held in Orl<str<strong>on</strong>g>and</str<strong>on</strong>g>o, Florida, October 21-25, 2004. Several chapter members will be participating in that meeting, including Dr. Rob Lawrencefrom the University of Florida. Informati<strong>on</strong> about the meeting can be found at www.bfmed.org. Applicati<strong>on</strong> has been made for AAPco-sp<strong>on</strong>sorship of the meeting.Goals for the future include c<strong>on</strong>tinued educati<strong>on</strong> of pediatric practiti<strong>on</strong>ers <str<strong>on</strong>g>and</str<strong>on</strong>g> ancillary health care pers<strong>on</strong>nel across the state <str<strong>on</strong>g>and</str<strong>on</strong>g>development of a multidisciplinary statewide breastfeeding coaliti<strong>on</strong>.IndianaIndiana Chapter ActivitiesBy Kinga A Szucs, MD, FAAPThe Indiana <strong>Breastfeeding</strong> Task Force is currently working <strong>on</strong> the Indiana State <strong>Breastfeeding</strong> Plan following a training c<strong>on</strong>ference by BestStart Social Marketing last year, which enabled a state-wide breastfeeding needs assessment <str<strong>on</strong>g>and</str<strong>on</strong>g> helped evaluate rates by county <str<strong>on</strong>g>and</str<strong>on</strong>g> barriersto breastfeeding. The Task Force includes representatives from the Indiana WIC Program, Indiana State Department of Health Maternal <str<strong>on</strong>g>and</str<strong>on</strong>g>Child Health Services, Indiana Perinatal Network, Healthy Mothers, Healthy Babies, Healthy Start, LLLI, as well as a breastfeeding motherrepresentative <str<strong>on</strong>g>and</str<strong>on</strong>g> myself from the AAP.With the launch of the Nati<strong>on</strong>al <strong>Breastfeeding</strong> Campaign, we are organizing a subcommittee, within the Task Force, to deal with involving themedia as much as possible. There will also be various health fairs coming up at our Community Health Centers, al<strong>on</strong>g with the Indiana BlackExpo Summer Celebrati<strong>on</strong> Black <str<strong>on</strong>g>and</str<strong>on</strong>g> Minority Health Fair which will give us a chance to reach more people in the community.For World <strong>Breastfeeding</strong> Week in August 2004, events included an Indianapolis Area Family Walk For <strong>Breastfeeding</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> the Midwest BreastFest in South Bend with the goal of trying to break the Guinness Book of World Records with the largest number of breastfeeding mothers<str<strong>on</strong>g>and</str<strong>on</strong>g> babies in <strong>on</strong>e place at <strong>on</strong>e time.Previous activities have included the Indiana Perinatal Network putting together the <strong>Breastfeeding</strong> Promoti<strong>on</strong> C<strong>on</strong>sensus Statement, followedby the Governor of Indiana issuing a <strong>Breastfeeding</strong> Proclamati<strong>on</strong>, in 2002, supporting breastfeeding for World <strong>Breastfeeding</strong> Week. In December2002, Methodist Hospital in Indianapolis became the first in the state with the Baby Friendly Hospital (BFHI) designati<strong>on</strong>, <str<strong>on</strong>g>and</str<strong>on</strong>g> c<strong>on</strong>tinues tobe the largest BFHI in the US. This has been followed by another hospital having an active Certificate of Intent <str<strong>on</strong>g>and</str<strong>on</strong>g> many others working towardspolicies <str<strong>on</strong>g>and</str<strong>on</strong>g> procedures that foster the BFHI principles. In July 2003, a law was enacted to remove legal barriers to breastfeeding inpublic: ”A woman may breastfeed her child anywhere the woman has a right to be.” Also in 2003, the Indiana <strong>Breastfeeding</strong> Resource H<str<strong>on</strong>g>and</str<strong>on</strong>g>bookupdated 4 th editi<strong>on</strong> was published <str<strong>on</strong>g>and</str<strong>on</strong>g> sent to physicians.Our future efforts will include legislative issues, such as providing health insurance coverage for breast pump rental, lactati<strong>on</strong> c<strong>on</strong>sultant services,<str<strong>on</strong>g>and</str<strong>on</strong>g> possibly for d<strong>on</strong>or human milk <str<strong>on</strong>g>and</str<strong>on</strong>g> a tax rebate for employers providing breastfeeding support to their employees. A few modelemployee lactati<strong>on</strong> programs have been identified that can be publicized <str<strong>on</strong>g>and</str<strong>on</strong>g> replicated in other workplace, hospital <str<strong>on</strong>g>and</str<strong>on</strong>g> clinic settings.