The Importance of Becoming Baby-Friendly Designated Trish MacEnroe, BS, CDN, CLC Baby-Friendly USA, Inc. info@babyfriendlyusa.org www.babyfriendlyusa.org

SPEAKER DISCLOSURES The speaker discloses employment with Baby-Friendly USA, Inc. 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 Breast Milk Substitutes.

INTERNATIONAL DATA UNICEF reports that there were nearly 20,000 Baby Friendly Hospitals worldwide. (2006)

~3250 total birthing facilities in US US DATA 156 Designated Facilities 595 working towards designation 11 facilities are finishing up the COI program (Assessment Results and QI Projects) 222 facilities in the Discovery Phase 274 facilities in the Development Phase 74 facilities in the Dissemination Phase 25 facilities in the Designation Phase ~3250 total birthing facilities in US

Why pursue Baby-Friendly designation? Benefits to the Hospital

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 Benefits to the Hospital # 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 Benefits to the Hospital # 7 - Deliver evidence-based, patient-centered care # 6 - Improve patient satisfaction # 5 - improve health outcomes for mothers and babies

Top 10 Benefits to the Hospital # 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 Benefits to the Hospital # 1 - Babies are born to be breastfed

4-D Dissemination Designation Development Discovery The Pathway to Baby-Friendly® Designation 4-D Baby-Friendly Designation Dissemination Bridge to Designation Phase Dissemination Certificate of Completion Designation Collect Data Implement QI Plan Readiness Interview On-Site Assessment Train Staff Bridge to Dissemination Phase- Development- Certificate of Completion Data Collection Plan Prenatal/Postpartum Teaching Plans Hospital Breastfeeding Policy Staff Training Plan Development Start BFHI Work Plan Discovery Bridge to Development Phase- Registry of Intent Award Register with Baby-Friendly USA Obtain CEO Support Letter Complete Self Appraisal Tool BF Committee Or Task Force © 2012 Baby-Friendly USA, Inc..

© Baby-Friendly USA, Inc. 2010 DISCOVERY Information Packet What is the BFHI 10 Steps International Code of Marketing of Breast Milk Substitutes Self Appraisal Tool Sample CEO Support Letter © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 DEVELOPMENT Guidelines and Evaluation Criteria Model Action Plans Budget planner Policy development tool Policy check off tool Community survey Patient education planning template Guidelines and Evaluation Criteria tell a facility everything they need in order to pass assessment The remaining tools are designed to help with the implementation of the Guidelines and Evaluation Criteria; Workplan –review self appraisal tool and mPINC identify strengths, identify challenges. Put together a plan to tackle the challenges. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 DEVELOPMENT Staff training requirements Staff training planning template Staff education documentation tool Data Collection planning template BFHI power point presentation © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 BFUSA Support Review and provide feedback Action Plans Infant feeding policy Staff training plan Patient education plan Data collection plan © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 DISSEMINATION Audit tools Code implementation Policy implementation Staff competency Staff knowledge Training implementation Patient knowledge Infant Feeding Outcomes Audit tools will consist of some staff and patient interview tools © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 DESIGNATION BFUSA/Facility participate in Readiness Assessment Telephone Interview Facility works with purchasing department to implement requirement to purchase infant formula, bottles and nipples Facility preparation for the on-site assessment BFUSA support in planning for on-site assessment Tell the truth during the readiness assessment interview Technical Assistance Team and On-Site Assessment team are not the same people. TA people do not talk to Assessment People and tell them about any conversations. Honesty during the readiness assessment interview can lead to a better outcome at the assessment We encourage putting off the purchasing of infant formula until the very end. This allows the facility time to get their exclusive breastfeeding rates to their highest levels, implement “in-house use only” policies for infant formulas and put formulas in medicine dispensers. Facilities should also have worked to obtain a better handle on usage © Baby-Friendly USA, Inc. 2010

To attain Baby-Friendly designation, a birth facility: Implements the Ten Steps to Successful Breastfeeding Invites a Baby-Friendly survey team when it is determined that the Ten Steps are in place. Undergoes an on-site survey looking at the knowledge and practice of staff and the experience of mothers and babies The “Baby-Friendly” award is made after a facility implements all Ten Steps to Successful Breastfeed and invites Baby-Friendly USA to send a survey team to verify that all 10 Steps have been correctly implemented. The assessment process consists of 2 parts: an on-site evaluation and a review of the assessment findings by an External Review Board. The on site assessment occurs after a facility’s readiness is confirmed by Baby-Friendly USA staff. A team of outside assessors then visits the facility and undertakes a series of interviews and document reviews. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 The Assessment Team The team creates a report that blinded and then sent out to an external review board. This board reviews the report and determines whether the facility receives the Baby-Friendly designation. Results are available within 6 to 8 weeks of assessment. The findings of the on-site assessment team are then summarized into a report. The report is blinded and sent to an External Review Board. The ERB reviews the findings and determines whether designation should be awarded. The facility is then notified of the ERBs decision, usually within 6-8 weeks. They receive a copy of the report completed by the assessors. Designated facilities receive a lovely piece of artwork with an engraved plaque commemorating their achievement. © Baby-Friendly USA, Inc. 2010

Most Important Document Musical Program Introduction 4 – Uses: Use this slide for a musical introduction to your presentation. You may also want to sequence additional slides into your introduction including a presentation title slide, team/player name slide, and/or rules slide. To Edit: Click on the text above to edit. The above images are easily changed in PowerPoint 2007 and 2010 by right clicking on the images above, selecting “Change Picture”, then browsing to, and selecting, an alternative JPEG or GIF image file on your computer. By using “Change Picture” the slide animation will not be lost (Unfortunately this feature is not available in earlier PowerPoint versions). To resize, click on the image, place your mouse in any corner of the image (a double headed arrow appears) click and hold down on the arrow while you expand or decrease the size of the image. Click and drag image into position or move into position by holding down the CTRL key and nudging with the Arrow keys into position. To Operate: When this slide appears in Slideshow Mode the music and animation will begin automatically. The slide is also set to automatically advance to the next slide. Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this slide from any other slide within your presentation as well as “Last Slide Viewed” buttons. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

BFUSA GUIDELINES AND EVALUATION CRITERIA ON-LINE Guideline - the standard of care to strive to achieve for all patients Criteria for Evaluation – the minimum standard that must be achieved in order to become designated as Baby-Friendly Always strive to achieve 100%. © 2012 Baby-Friendly USA, Inc..

© 2012 Baby-Friendly USA, Inc.. Name that Guideline The remaining portion of this presentation will pose a series of questions. You will be given 30 seconds to look up the answer in the Guidelines and Evaluation Criteria. After 30 seconds the answer will appear on the slide. Let’s move to the first question. Let’s Play © 2012 Baby-Friendly USA, Inc..

© 2012 Baby-Friendly USA, Inc.. Do the nursing staff in the NICU require training in all 15 lessons? GLEC page 8 Guideline says: “Training for nursing staff ON MATERNITY should comprise a total of 20 hours, inclusive of the 15 sessions identified by UNICEF/WHO plus 5 hours of supervised clinical experience. The facility should determine the amount and content of training required by staff in other units and roles by their anticipated workplace exposure to mothers and babies.” OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

INTENTIONALLY BROAD WORDING There are wide variations in facility structure and operations throughout the country. The guidelines cannot address each facility’s specific situation. For example, some facilities will rotate their prenatal nurses onto the maternity floor If yes, provide the full 15 lessons to those staff If no, provide training appropriate to their specific duties It is not possible to write guidelines that will cover all possible circumstances because there are wide variations in facility structure, operations and resources throughout the country. Facilities should Review the Guidelines and Evaluation Criteria and consider their particular circumstances and decide the best way implement them. © 2012 Baby-Friendly USA, Inc..

NICU STAFF - SIMILAR SITUATION The NICU is vitally important to the BFHI, but is not included in the current assessment Consider if NICU nurses are rotated onto the maternity floor If yes, provide the full 15 lessons to those staff If no, provide training appropriate to their specific duties © 2012 Baby-Friendly USA, Inc..

© 2012 Baby-Friendly USA, Inc.. Do we have to train all staff, including housekeeping? GLEC page 8 Guideline says: The facility should determine the amount and content of training required by staff in other units and roles by their anticipated workplace exposure to mothers and babies…The content and number of hours of training for staff working outside maternity will be developed by each facility, based on job description and workplace exposure to breastfeeding couplets. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. Training for all staff Logically, all staff who have contact with mothers, including housekeeping, should have basic understanding of the importance of exclusive breastfeeding know their role with supporting the BF couplet feel comfortable with witnessing the practices that support breastfeeding know who to call if a mother has a question or problem with breastfeeding © 2012 Baby-Friendly USA, Inc..

© 2012 Baby-Friendly USA, Inc.. May we accept training that meets the BFHI requirements that occurred prior to employment? GLEC page 8 Guideline says: If training acquired prior to employment with this facility is accepted, as a means of meeting the minimum competencies, the designated health care professional will be able to describe the process used to verify the previously acquired competencies. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

Development Phase Training Plan Asks the facility to describe If prior training will be accepted What evidence of training completion will be accepted How the program will be evaluated to determine if all lessons were covered How staff competencies will be verified © 2012 Baby-Friendly USA, Inc..

© 2012 Baby-Friendly USA, Inc.. What topics should be covered in prenatal education? . GLEC page 10 Guideline says the education should cover: The importance of exclusive breastfeeding Basic breastfeeding management (including the importance of early skin-to-skin contact, early initiation of breastfeeding, rooming-in, baby-led feeding, how to develop milk supply, effective positioning and attachment) Individualized education on the documented contraindications to breastfeeding and other special medical conditions OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. What is the definition of skin-to-skin? GLEC page 30 Definition says: Skin-to-skin contact refers to contact between the newborn infant and its mother (although in the case of incapacitation of the mother, another adult such as the baby’s father or grandparent may hold the baby skin-to-skin). After birth, the healthy term baby should be completely dried and the baby should be placed naked against the mother’s naked ventral surface. The baby may wear a diaper and/or a hat, but no other clothing should be between the mother’s and baby’s bodies. The baby and mother are then covered with a warmed blanket, keeping the baby’s head uncovered. STS contact should continue, uninterrupted, until the completion of the first feeding (or for at least 1 hour if the mother is not breastfeeding). STS contact should be encouraged beyond the first hours and into the first days after birth. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. Which mothers and babies need to be placed skin-to-skin and when?. GLEC page 11 says: Step 4 applies to all healthy mothers and babies regardless of infant feeding choice. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. What Step requires staff to teach hand expression to breastfeeding mothers? GLEC page 13 Step 5 says: Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants. GLEC page 13 Evaluation Criteria: At least 80% of those who are breastfeeding will report that they were shown how to express their milk by hand. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. Which babies and mothers should “room-in” during their post-partum stay?. GLEC page 16 Step 7 Guideline says: The facility shall provide rooming-in twenty-four hours a day as the standard for mother-baby care for healthy, full term infants, regardless of feeding choice. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. Which mothers need to be taught baby feeding cues? GLEC page 17 Step 8 says: This step applies to all babies, regardless of feeding method, and is not interpreted as “Encourage feeding on cue”. ?OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. Can Baby-Friendly hospitals provide pacifiers to their patients? GLEC page 18 Guideline says: Breastfeeding babies should not be given pacifiers by the facility, with the exception of limited use to decrease pain during procedures when the baby cannot safely be held or breastfed…babies who are being tube-fed in NICU, or for other rare, specific medical conditions. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. What kinds of breastfeeding support information should be shared with breastfeeding women? When should this information be shared? GLEC page 19 Step 10 says: Breastfeeding women should be given information about community programs such as LLL or WIC in addition to hospital based breastfeeding support at the time of discharge. OPEN ENDED QUESTION with button to reveal answer. Comes with a 30 and 60 second timer which can be deleted if desired. Uses: Interject questions throughout your presentation to make the presentation fun, interactive and engaging. Divide your audience into teams ( 2 – 6 teams). Use this program’s built-in scoreboard to tally team/player scores. To Edit: While in Edit Mode, click on the text within the slide text boxes and begin typing. After entering your question, place the correct answer in the box below the answer that reads “Enter the correct answer here. To Operate: In Slideshow Mode, click on the answer button to reveal the correct answer (Applause sound is heard). Place this slide strategically within your presentation or use this program’s slide navigation buttons to access this and other slides from anywhere within your presentation. © 2012 Baby-Friendly USA, Inc.. Refer to notes section below for help or tips about this slide. Copyright © 2012 Training Games, Inc.

© 2012 Baby-Friendly USA, Inc.. YOUR CHALLENGE Review the Guidelines and Evaluation Criteria Consider your particular circumstances and how you will implement them in the context of Resources Staffing Physical plant Your circumstances Remember it is not possible to write guidelines that will cover all possible circumstances because there are wide variations in facility structure, operations and resources throughout the country. Facilities should Review the Guidelines and Evaluation Criteria and consider their particular circumstances and decide the best way implement them. © 2012 Baby-Friendly USA, Inc..

HOW THE 4-D PATHWAY HELPS FACILITIES SUCCEED The 4-D Pathway was designed to provide facilities with some structure, guidance and tools to aid them in their journey to become Baby-Friendly designated. Baby-Friendly USA is very grateful for the input provided by the pioneering early implementers of the initiative since their experiences helped structure this program. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 To help foster an understanding that Baby-Friendly is a facility initiative, not just a lactation project… The Baby-Friendly Hospital Initiative assesses maternity care practices that support optimal infant nutrition and mother/baby bonding. However, the impact of the initiative is far reaching throughout the facility. In order to make the transformational changes necessary to achieve designation, widespread facility support is required. Soooooo….. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 4-D Pathway Requires CEO Letter of Support Formation of multi-disciplinary team to implement the BFHI Guidelines Creation of multi-disciplinary team to review the results of mPINC and BFUSA self-appraisal tool and develop a workplan to address low scoring areas The 4-D Pathway requires” CEO Letter of Support - There will be times throughout the journey that the support of leadership will be crucial to success. To set the stage for the engagement of senior leadership, BFUSA requires a facility to obtain a letter of support from an executive officer. The work of transforming maternity care practices to support breastfeeding impacts many disciplines. To achieve the greatest buy in for change it is best to involve all disciplines impacted by the change. That is why the Development Phase calls for the creation of a multi-disciplinary task force to review the results of the mPINC and Self-Appraisal Tool, develop a plan and work to implement the Baby-Friendly Guidelines and Evaluation Criteria. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 To help ensure that the facility infant feeding policy is comprehensive and that other facility policies do not countermand the infant feeding policy… A fundamental belief of the Baby-Friendly Hospital Initiative is that policy drives practice. Comprehensive policies and procedures are needed in order to fully implement the Guidelines and Evaluation Criteria. Sooo. To help assure that the facility infant feeding policy is comprehensive and that other facility policies do not countermand the infant feeding policy. Next Slide © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 4-D Pathway Provides Development Phase Policy development guidance tool Policy check off tool review and feedback on the policy Dissemination Phase Provide quality improvement audit tool Designation Phase Inquire about policy changes, review policy during assessment The 4-D Pathway provides policy development and check off tools in the Development Phase Tool kit. The policy check off tool provided here is the same tool used in the assessment of Step 1. To further assist facilities with success with their policy, Baby-Friendly USA reviews and provides feedback on the policy during the Development Phase. © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 To help facilities consider how they will ensure that all staff are fully trained and have the competencies needed to provide evidence-based, patient-centered care that promotes optimal infant nutrition and mother baby bonding… A fundamental belief of the Baby-Friendly Hospital Initiative is that policy drives practice. Comprehensive policies and procedures are needed in order to fully implement the Guidelines and Evaluation Criteria. Sooo. To help assure that the facility infant feeding policy is comprehensive and that other facility policies do not countermand the infant feeding policy. Next Slide © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 4-D Pathway Provides Development Phase – Training plan template that addresses key issues List of required training topics Training document tool Review and feedback on training plans Dissemination Phase Provide quality improvement audit tools Designation Phase Review of curriculum and training records during assessment © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 To help facilities consider how they will provide and document consistent, evidence-based patient education… A fundamental belief of the Baby-Friendly Hospital Initiative is that policy drives practice. Comprehensive policies and procedures are needed in order to fully implement the Guidelines and Evaluation Criteria. Sooo. To help assure that the facility infant feeding policy is comprehensive and that other facility policies do not countermand the infant feeding policy. Next Slide © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 4-D Pathway Provides Development Phase Patient education plan template that addresses key issues List of required patient education topics Review and feedback on patient education plans Dissemination Phase Provide quality improvement audit tools Designation Phase Review of education curriculum, materials and records during assessment © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 To help facilities measure their performance and infant feeding outcomes to evaluate their implementation of the Baby-Friendly Guidelines and Evaluation Criteria… A fundamental belief of the Baby-Friendly Hospital Initiative is that policy drives practice. Comprehensive policies and procedures are needed in order to fully implement the Guidelines and Evaluation Criteria. Sooo. To help assure that the facility infant feeding policy is comprehensive and that other facility policies do not countermand the infant feeding policy. Next Slide © Baby-Friendly USA, Inc. 2010

© Baby-Friendly USA, Inc. 2010 4-D Pathway Provides Development Phase Data collection planning document Data collection plan template Dissemination Phase Provide quality improvement audit tools Designation Phase Readiness assessment telephone interview to assist in determining facility preparedness for the on-site assessment © Baby-Friendly USA, Inc. 2010

Re-designation Process Maintaining excellence

Success is a journey…not a destination Achieving Baby-Friendly designation is an important part of the journey…but it is not the end point On-going data collection and quality improvement activities are vital to ensuring that facilities maintain the standard of care they worked hard to achieve © Baby-Friendly USA, Inc. 2010

Re-Designation Process Designation is for 5 years Beginning in 2017 Re-designation will be conferred through an on-site assessment Current re-designations are conducted through a review of data and quality improvement projects © Baby-Friendly USA, Inc. 2010

Re-Designation Procedure 2012 - 2016 3 Phases: Phase I – Step 1 - Infant Feeding Policy and Code Compliance Phase II – Step 2-10 Compliance – Audit of Practices Phase III – Implementation of Quality Improvement Plans © Baby-Friendly USA, Inc. 2010

BFUSA Annual Monitoring Process Facilities audit practices on assigned steps and conduct QI projects as necessary

BFUSA Annual Monitoring Designated facilities audit practices and conduct QI projects on 2 steps per year Steps are assigned by BFUSA Audit Tools are provided by BFUSA There is an annual fee to BFUSA © 2012 Baby-Friendly USA, Inc..

Baby-Friendly Re-Designation Re-verify Staff Competency Review/update Staff Education Review policies Reinstitute QI Activities Reaffirm Code Implementation Patient Education Review Patient Outcomes data Baby-Friendly Re-Designation On-Site Re-Assessment © 2012 Baby-Friendly USA, Inc.

Re-Designation is the same as the Dissemination and Designation Phases © 2012 Baby-Friendly USA, Inc..

Annual QI and Re-designation Utilize the same Audit Tools as the Dissemination Phase of the 4-D Pathway

© Baby-Friendly USA, Inc. 2010 FOR MORE INFORMATION: www.babyfriendlyusa.org info@babyfriendlyusa.org 508-888-8092 (9-5 Eastern, M-F) © Baby-Friendly USA, Inc. 2010