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<p>Introduction: Initiation of breastfeeding is almost universal in American Samoa, but duration of exclusive breastfeeding is short. Increasing the duration of exclusive breastfeeding may be an efficacious strategy for childhood obesity prevention in American Samoa.</p><p>Aim: To understand influences on infant feeding in American Samoa and to identify potential barriers to exclusive breastfeeding</p><p>Methods: A mixed-methods, prospective study following Samoan women (n=44), their partners, and their infants from late pregnancy (average 37 weeks gestation) until eight weeks post-partum was completed in 2013. Participants reported intentions for infant feeding before birth, and practices were self-reported in questionnaires completed at 3- and 8-weeks postpartum.</p><p>Results: While 79.5% of women intended to exclusively breastfeed for the first few weeks postpartum, less than 40% were exclusively breastfeeding at 3-weeks postpartum. Many women of the women who introduced formula before 3-weeks did so before hospital discharge. Barriers to exclusive breastfeeding included lack of skin-to-skin contact after delivery, delays in the initiation of breastfeeding, pain during breastfeeding, and a lack of education about infant satiety cues.</p><p>Discussion: Structural rather than individual level barriers to breastfeeding were identified by American Samoan women. Existing evidence-based interventions to promote exclusive breastfeeding could be adapted for use in this setting and should begin before hospital discharge. </p>

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Introduction The objectives of this performance improvement project is to facilitate earlier goals of care discussions led by the Palliative Care team for burn patients with a high risk of mortality, and to improve overall communication with families of patients. The Advanced Care Planning Trigger Tool utilizes the Revised Baux Score, a burn mortality scoring system, which is calculated by adding the patient’s age, total body surface area (TBSA) of the patient’s burn as a whole number, and adding an additional 17 points if the patient has an inhalation injury. From January 1st, 2017 to June 1st, 2018 16 patients were admitted to the Burn Center with a Revised Baux Score of over 100. Of those 16 patients, 11 passed away due to their injuries during admission, equaling a 69% mortality. Palliative Care consults were triggered for 4 out of the 16 patients (25%), and all 4 of these patients passed away during their hospital stay. Methods Revised Baux Score is calculated on each new burn admission. A consult to the Palliative Care Team for Advanced Care Planning is triggered within 48 hours of admission, if a patient’s Revised Baux Score is above 110 and they are greater than 60 years old; or any adult patient (over 18 years old) with a score of 130 or greater. Results The project was implemented in June of 2018. This tool led to an increase in Palliative Care team involvement early on for patients with a high risk of mortality from their burn injury, more effective care planning discussions with families and improved collaboration between the Burn team and Palliative Care team. Conclusions All patients with a Revised Baux Score that triggered the Advanced Care Planning Tool for a consult were ordered palliative care consults within 48 hours of admission. Applicability of Research to Practice Advanced Care Planning with the Palliative Care team leads to increased communication and more effective care planning for patients with a high risk of mortality.

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