Perspectives on Promoting Breastmilk Feedings for Premature Infants During a Quality Improvement Project

Lee, Henry Chong; Martin-Anderson, Sarah; Lyndon, Audrey; Dudley, R. Adams

doi:10.1089/bfm.2012.0056

Cited by 13 publications

(9 citation statements)

References 26 publications

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“…The input of staff is also highly valuable in the use of QI in the health care setting because many QI projects involve active participation and buy-in from a multidisciplinary staff. 2,17,18 Similarly important was the desire to improve recruitment without pressuring families to participate. Thus, certain tests of change, such as compensation for the child, were discussed with the CCHMC IRB before implementation, and care was taken to ensure that there was appropriate balance between compensation and coercion.…”

Section: Discussionmentioning

confidence: 99%

Increasing Recruitment Rates in an Inpatient Clinical Research Study Using Quality Improvement Methods

Sauers¹,

Beck

Kahn

et al. 2014

Hospital Pediatrics

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Objective One important benefit of successful patient recruitment is increased generalizability of findings. We sought to optimize enrollment of children admitted with asthma as part of a population-based, prospective, observational cohort study with the goal of enrolling at least 60% of all eligible and staffed patients. Methods Quality improvement methods were used to improve cohort recruitment. Weekly meetings with study staff and study leadership were held to plan and discuss how to maximize recruitment rates. Significant initial variability in recruitment success prompted the team to use small-scale tests of change to increase recruitment numbers. A number of tests were trialed, focusing primarily on reducing patient refusals and improving recruitment process efficiency. Recruitment rates were calculated by dividing eligible by enrolled patients and displayed using annotated Shewhart control charts. Control charts were used to illustrate week-to-week variability while also enabling differentiation of common-cause and special-cause variation. Results The study enrolled 774 patients, representing 54% of all eligible and 59% of those eligible for whom staff were available to enroll. Our mean weekly recruitment rate increased from 55% during the first 3 months of the study to a statistically significant sustained rate of 61%. This was sustained given numerous obstacles, such as departing and hiring of staff and adding a second recruitment location. Conclusions Implementing quality improvement methods within a larger research study led to an increase in the rate of recruitment as well as the stability in recruitment rates from week-to-week.

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Section: Discussionmentioning

confidence: 99%

Increasing Recruitment Rates in an Inpatient Clinical Research Study Using Quality Improvement Methods

Sauers¹,

Beck

Kahn

et al. 2014

Hospital Pediatrics

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“…Staff input is known to be highly valuable in the use of QI in the health care setting, as many QI projects involve active participation and buy-in from a multidisciplinary staff. [8][9][10] By engaging night staff when we expanded the program to all patients, we were able to begin the process on admission. During the asthma-only phase of the program, we were relying primarily on the daytime staff, which caused us to miss patients who were admitted late in the day and ready to be discharged the following day.…”

Section: Discussionmentioning

confidence: 99%

Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital

Sauers‐Ford¹,

Moore

Guiot³

et al. 2016

Pediatrics

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The World Health Organization 2003 report on medication adherence 1 quoted Haynes that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." An obvious, yet critical, component to medication adherence is access to medications; consequently the failure either to fill new prescriptions or to refill existing ones is a critical point of failure in the postdischarge care of patients. 1, 2 Previous work at our institution has demonstrated a sustained reduction in hospital and emergency department (ED) reutilization in part due to efforts abstract OBJECTIVES: In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS:A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS:During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS: Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.

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“…Based on the extant literature (Lee et al, 2013) and application of social scientific theories (Ajzen and Fishbein, 1977) (Blyth et al, 2002) (Elder et al, 1999), we hypothesized that the following factors would increase both exclusivity and likelihood of breast milk feeding.…”

Section: Hypothesesmentioning

confidence: 99%

“…We used theories from previous research (Lee et al, 2013) (Ajzen and Fishbein, 1977) (Blyth et al, 2002) (Elder et al, 1999), to construct a survey tool that addressed multiple categories of breast milk feeding determinants. The three categories below are included in this paper:…”

Section: Development Of the Survey Instrumentmentioning

confidence: 99%

Maternal determinants of breast milk feeding in a level III neonatal intensive care unit

Martin-Anderson

Lee

2015

Journal of Neonatal Nursing

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Perspectives on Promoting Breastmilk Feedings for Premature Infants During a Quality Improvement Project

Abstract: Optimizing communication among health professionals and parents and improving team composition may be key components of facilitating breastmilk feeding promotion in premature infants.

Cited by 13 publications

References 26 publications

Increasing Recruitment Rates in an Inpatient Clinical Research Study Using Quality Improvement Methods

Increasing Recruitment Rates in an Inpatient Clinical Research Study Using Quality Improvement Methods

Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital

Maternal determinants of breast milk feeding in a level III neonatal intensive care unit

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