Download:
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pdf mPINC
CDC Survey of
Maternity Practices in Infant Nutrition and Care
2O15 Survey Results
Benchmark
Re rt
«FacStreet»
National Center for Chronic Disease Prevention and Health Promotion
Division of Nutrition, Physical Activity, and Obesity
mPINC
2015 Survey
Facility Benchmark Report
Summary Information
«FacName»’s
Total Score:
«To
What is the mPINC Survey?
The Maternity Practices in Infant Nutrition and Care (mPINC) Survey
is a national survey of infant feeding practices in maternity care
settings. Every two years, all U.S. hospitals that provide maternity
services and free-standing birth centers are invited to participate.
Battelle has conducted this survey for the Centers for Disease Control
and Prevention (CDC) since 2007.
«FacName»’s
Total Score Percentilesi
United States
(Percentile compared to all facilities nationwidei)
«statename»
(«State %ile»)
Similar Size Facilities
(Percentile compared to all US facilities with
births per yearii)
«Totalnatlbar»«TotNatODDbar»
«Totalnatlbar»«TotNatODDbar»
«Total_natl»
«Totalstatebar»«TotStateODDbar»
«Totalstatebar»«TotStateODDbar»
«Totalsizelbar»«TotSizeODDbar»
«Totalsizelbar»«TotSizeODDbar»
«Total_state»
«Total_size»
0
100
«FacName» reported «Numbirths» births in the past year; it is in the size
category of «Births_range» births per year.
i Your
facility’s percentile is the point below which the indicated percent of scores fall in each group. For example, if your National percentile is 50, then you are performing better
than half of all facilities nationwide. If your State percentile is 66 or 67, you are performing better than about two-thirds of the facilities in your state. If your Similar Size percentile is
99, you are performing better than almost all other facilities nationwide with a similar number of births per year.
ii Facility size estimates are based on annual birth census as reported by the mPINC survey respondent and/or the American Hospital Association (when respondent did not provide
data).
2
mPINC
2015 Survey
Facility Benchmark Report
What is in this report?
«FacName»’s results from the 2015
mPINC survey.
What do these results mean?
Total Score is an overall quality score that
ranges from 0 to 100. It averages the Care
Dimension Subscores on 7 aspects of care.
Care Dimension Subscoresiii are calculated for
labor and delivery care; postpartum feeding of
breastfed infants, breastfeeding assistance, and
contact between mother and infant; discharge
care; staff training; and structural/organizational
aspects of care delivery at your facility.
Percentiles are calculated to compare your
practices to all other facilities across the US, in
«statename», and in your size category
nationwide.
Best Practices in Infant Feeding Care
The following key clinical care
processes, policies, and staffing
expectations are appropriate for all
perinatal patients, unless medically
contraindicated:
I. Labor and delivery care
Upon delivery,iv the newborn is placed
skin-to-skin with the mother, allowing
uninterrupted time for breastfeeding.
II. Postpartum care:
a. Feeding of breastfed infants
The breastfeeding infant is only offered
pacifiers and supplements (infant
formula, water, and glucose water)
when medically indicated.
b. Breastfeeding assistance
Who participates in mPINC?
All facilities that provide intrapartum care in the
United States and Territories are invited to
participate in the mPINC survey.
The people most knowledgeable about the care
processes and policies involved in feeding
healthy infants at each facility complete the
survey on behalf of their facility.
The 2015 survey response rate was 82%.
Maternity Care Practices
Infant Feeding
A group of specific interventions has been identified
that, when implemented together as a consistent
system of care,1-3 results in better breastfeeding
outcomes.4-8 Inpatient and ambulatory intrapartum
care strategies describe how infant feeding care is
delivered across the perinatal period. These strategies
are designed to reduce the incidence of events and
experiences that undermine mothers’ breastfeeding
intentions and decisions.
The key components of this care system were
identified using the best available science and
evidence. Like other clinical care models, this
evidence spans a wide range, from results of
randomized trials to expert opinion, producing a set
of connected best practices that make up a facility’s
infant feeding care system.
iii Care
Dimension Subscores are calculated as a simple average of the individual item scores
within each domain. Subscores are not calculated when less than half of items in that
domain received a score.
Assistance is offered to the
breastfeeding mother and infant
using standards for supportive
patient education and assessment.
c.
The infant is enabled by staff to
stay with the mother 24 hours per
day, without unnecessary
separation or restrictions.
III. Facility discharge care
The breastfeeding mother and infant
are assured ambulatory breastfeeding
care, and patient discharge gifts
contain no infant formula marketing
samples.
IV. Staff training
All staff with primary responsibility for
care of the breastfeeding mother and
infant receive
breastfeeding
skills training and assessment.
V. Structural and organizational
aspects of care delivery
Best practices and policies are
implemented for staffing, care process,
and communication expectations;
policies are supportive of breastfeeding
employees; and are free from financial
conflict of interest.
iv Immediate
skin-to-skin contact and breastfeeding opportunities are
possible and beneficial in both vaginal and Cesarean deliveries. These
practices should be initiated within one hour of vaginal birth and
within two hours of Cesarean birth.
3
mPINC
2015 Survey
Subscore Percentiles compare your facility’s subscore to:
Facility Benchmark Report
United States
«statename»
I. Labor and Delivery Care
Measure
Initial skin-toskin contact
Subscore:
Initial
breastfeeding
opportunity
Early initiation of breastfeeding increases overall
breastfeeding duration and reduces a mother’s risk
of delayed onset of milk production.10
Routine
procedures
performed
skin-to-skin
Performing routine newborn procedures and
assessments skin-to-skin increases infant stability,
is safe for mother and infant,11 and improves
breastfeeding outcomes by reducing unnecessary
separation of mother and infant.12
«LabDel_natl»
«LDstatebar»«LDstateODDbar»
«LDsizebar»«LDsizeODDbar»
«LabDel_state»
«LabDel_size»
0
100
Ideal
Response
Your
Response
This measure reports how many patients experience
mother-infant skin-to-skin contact for at least 30 minutes
within 1 hour of uncomplicated vaginal birth.
Most
«a05respons
e»
This measure reports how many patients experience
mother-infant skin-to-skin contact for at least 30 minutes
within 2 hours of uncomplicated Cesarean birth.
Most
«a11respons
e»
This measure reports what percent of patients have the
opportunity to breastfeed within 1 hour of uncomplicated
vaginal birth.
≥90
«a06respons
e»
This measure reports what percent of patients have the
opportunity to breastfeed within 2 hours of uncomplicated
Cesarean birth.
≥90
«a12respons
e»
Almost
always
«a04respons
e»
Rationale
Skin-to-skin contact improves infant ability to
establish breastfeeding.9
«La
Similar Size Facilities
«LDnatlbar»«LDnatODDbar»
Explanation
This measure reports how often patients have routine infant
procedures performed while mother and infant are skin-to-skin.
Your
Score
«a05s
core»
«a11s
core»
«a06s
core»
«a12s
core»
«a04s
core»
Subscore Percentiles compare your facility’s subscore to:
II. Postpartum Care—
a. Feeding of Breastfed
Infants
Measure
Rationale
Initial feeding
received after
birth
Neonatal immune system development depends on
transfer of specific antibodies through colostrum
and is impaired by prior introduction of non-breast
milk feeds.13,14
Supplementary
feedings
The AAP and ACOG Guidelines for Perinatal
Care15 and Academy for Breastfeeding Medicine
guidelines for supplementing feedings in healthy16
and hypoglycemic17 neonates all recommend
against routine supplementation with formula,
glucose water, or water.
4
United States
«statename»
Subscore:
«Fe
Similar Size Facilities
«Feednatlbar»«FeednatODDbar»
«FeedBF_natl»
«Feedstatebar»«FeedstateODDbar»
«Feedsizebar»«FeedsizeODDbar»
«FeedBF_state»
«FeedBF_size»
0
100
Ideal
Response
Your
Response
This measure reports what percent of breastfeeding infants
receive breast milk as their first feeding after uncomplicated
vaginal birth.
≥90
«a07respons
e»
This measure reports what percent of breastfeeding infants
receive breast milk as their first feeding after uncomplicated
Cesarean birth.
≥90
«a13respons
e»
This measure reports what percent of breastfeeding infants
receive non-breast milk feedings.
<10
«a20respons
e»
This measure reports whether breastfeeding infants receive
glucose water and/or water.
No
«a21respons
e»
Explanation
Your
Score
«a07s
core»
«a13s
core»
«a20s
core»
«a21s
core»
mPINC
2015 Survey
II. Postpartum Care—
b. Breastfeeding Assistance
Measure
Pacifier use
«BF
«statename»
Similar Size Facilities
«Assistnatlbar»«AssistnatODDbar»
«BFAssist_natl»
«Assiststatelbar»«AssiststateODDbar»
«Assistsizebar»«AssistsizeODDbar»
«BFAssist_state»
«BFAssist_size»
0
100
Your
Score
Ideal
Response
Your
Response
Almost
always
«a03respon
se»
«a03s
core»
Most
«a15respon
se»
«a15s
core»
This measure reports how many patients are taught to recognize
and respond to infants’ cues instead of feeding on a set schedule.
Most
«a16respon
se»
This measure reports how often breastfeeding patients receive
instructions to limit suckling at the breast to a specific length of
time.
Rarely
The AAP recommends formal evaluation of
breastfeeding performance by trained observers
during the first 24-48 hours of life.19
This measure reports how many patients received a directly
observed breastfeeding assessment by facility staff.
Most
«a18respon
se»
Standardized breastfeeding assessment tools
improve comparability and validity of findings.23-25
This measure reports whether breastfeeding is assessed using a
standardized or adapted assessment tool.
Yes
«a19respon
se»
In-hospital pacifier use reduces duration of
exclusive breastfeeding.26
This measure reports how many breastfeeding patients are given
pacifiers by facility staff.
Few
«a24respon
se»
Rationale
Explanation
This measure reports how often infant feeding decisions are
documented in medical records.
The AAP recommends pediatricians provide
parents with complete, current information on the
This measure reports how many patients who are breastfeeding,
benefits and methods of breastfeeding to ensure
intend to breastfeed, are provided advice and instructions
that the feeding decision is a fully informed one.19 orabout
breastfeeding.
Patient education is important in order to establish
20,21
breastfeeding.
Effective breastfeeding relies on feeding in direct
response to specific infant cues rather than
scheduled frequency or duration of feedings.22
Assessment
and
observation of
breastfeeding
sessions
United States
Subscore:
Standard documentation of infant feeding
decisions is important in order to adequately
support maternal choice.18
Breastfeeding
advice and
counseling
Subscore Percentiles compare your facility’s subscore to:
Facility Benchmark Report
«a16s
core»
«a17s
core»
«a18s
core»
«a19s
core»
«a24s
core»
Subscore Percentiles compare your facility’s subscore to:
II. Postpartum Care—
c. Contact Between
Mother and Infant
Measure
Separation of
mother and
newborn
during
transition to
receiving units
Patient
rooming-in
Instances of
mother infant
separation
United States
«statename»
Subscore:
«Co
Similar Size Facilities
«Contactnatlbar»«ContactnatODDbar»
«Contact_natl»
«Contactstatebar»«ContactstateODDbar»
«Contactsizebar»«ContactsizeODDbar»
«Contact_state»
«Contact_size»
0
Rationale
Explanation
Ideal
Response
Separation during transition to postpartum care is
unnecessary for stable patients. Mother-infant contact is
important during this time to establish breastfeeding,
maintain infant weight, and improve regulation of
infants’ neurologic states.22
This measure reports how many minutes mother-infant
pairs are separated after uncomplicated vaginal births
during the transition from labor and delivery care to their
receiving patient care units.
No
separation
«a08respons
e»
This measure reports how many hours breastfeeding
mother-infant pairs are separated at night.
No
separation
«a28respons
e»
≥90
«a31respons
e»
0
«a30respons
e»
Most
«a29respons
e»
Rooming-in of mother-infant pairs increases infants’
opportunities to learn to breastfeed28 without affecting
duration or quality of maternal sleep.29
Understanding the reasons mother-infant pairs are
separated30 helps identify opportunities to reduce
unnecessary separations. Bringing the infant to the
mother to breastfeed reduces chances the infant will
receive supplemental feeds.31,32
This measure reports what percent of mother-infant pairs
room together ≥23 hrs per day.
This measure reports the number of reasons that infant
patients are removed from mothers’ rooms.
This measure reports how many patients who are not
rooming-in receive the infant from the nursery for
breastfeeding at night.
Your
Response
100
Your
Score
«a08s
core»
«a28s
core»
«a31s
core»
«a30s
core»
«a29s
core»
5
mPINC
2015 Survey
III. Facility Discharge Care
Measure
Subscore Percentiles compare your facility’s subscore to:
Facility Benchmark Report
United States
Subscore:
Rationale
«Dx
«statename»
Similar Size Facilities
«Dxnatlbar»«DxnatODDbar»
«Dx_natl»
«Dxstatebar»«DxstateODDbar»
«Dxsizebar»«DxsizeODDbar»
«DX_state»
«Dx_size»
0
Explanation
Assurance of
ambulatory
breastfeeding
support
This measure reports how many modes of ambulatory
The AAP clinical practice guidelines recommend
examination of all infants by a qualified health care breastfeeding support are offered:
Physical Contact—Home/hospital visit;
professional within 48 hours of hospital discharge
Active Reaching Out—Phone call to patient;
to assess breastfeeding.33 Ensuring post discharge
Referral—Providing information about:
ambulatory support improves breastfeeding
Available phone numbers, support groups, lactation
34-35
consultant/specialist, WIC, outpatient clinics.
outomes.
Distribution of
“discharge
packs”
containing
infant formula
The AAP and ACOG recommend against
distributing infant formula “discharge packs”15,36
This measure reports whether breastfeeding patients are given
because it reduces exclusive breastfeeding rates and “discharge packs” containing product marketing infant formula
samples.
implies health care professional endorsement of
specific commercial items.37-39
100
Ideal
Response
Your
Response
Your
Score
All 3 modes
«a33resp
onse»
«a33s
core»
No
«a32resp
onse»
«a32s
core»
Subscore Percentiles compare your facility’s subscore to:
IV. Staff Training
Measure
Subscore:
Rationale
Preparation of
new staff
Continuing
education
Competency
assessment
6
Staff training ensures standard capacity to provide
evidence-based care, learn about39-42new information, and
maintain patient support skills. Staff training
improves patient breastfeeding outcomes facilitywide.43,44
«Tra
United States
«Trainnatlbar»«TrainstateODDbar»
«statename»
«Trainstatebar»«TrainstateODDbar»
Similar Size Facilities
«Trainsizebar»«TrainsizeODDbar»
«Train_natl»
«Train_state»
«Train_size»
0
100
Explanation
Ideal
Response
Your
Response
Your
Score
This measure reports how many hours of breastfeeding
education new nurses and other birth attendants* receive.
≥18
«b01resp
onse»
«b01s
core»
This measure reports how many hours of breastfeeding
education current nurses and other birth attendants*
receive.
≥5
«b05resp
onse»
«b05s
core»
This measure reports how many nurses and other birth
attendants* received any breastfeeding education in the
past year.
Most
«b04resp
onse»
«b04s
core»
This measure reports how often nurses and other birth
attendants* are assessed for competency in breastfeeding
management and support.
At least
once a year
«b03resp
onse»
«b03s
core»
* In free-standing birth centers, these questions were
asked among “birth attendants” to accommodate
the range of attendants to births in these facilities.
mPINC
2015 Survey
Subscore Percentiles compare your facility’s subscore to:
Facility Benchmark Report
V. Structural & Organizational
Aspects of Care Delivery
Subscore:
United States
«Str
«statename»
Similar Size Facilities
«Structnatlbar»«StructnatODDbar»
«Struct_natl»
«Structstatebar»«StructstateODDbar»
«Structsizebar»«StructsizeODDbar»
«Struct_state»
«Struct_size»
0
100
Rationale
Explanation
Ideal
Response
Your
Response
Your
Score
The AAP recommends inclusion of specific
elements in facility breastfeeding policies.15 The
Academy of Breastfeeding Medicine’s clinical
protocol lists components of a model breastfeeding
policy.16
This measure reports the number of model breastfeeding policy
elements in your facility’s breastfeeding policy.
10
«b11respo
nse»
«b11s
core»
Effective intra-professional communication
increases the likelihood that a facility’s
breastfeeding policy will be implemented
appropriately.48,49
This measure reports the modes used to inform staff about
breastfeeding policies:
In person—In-service training, new staff orientation, new
staff training, staff meeting;
Printed/online materials—Policy posted, newsletter.
Both
modes
«b12respo
nse»
«b12s
core»
Infant feeding
documentation
policy
Standardized documentation of patient decisions
allows for valid internal assessment, monitoring
and improvement of quality of care, and improves
staff collaboration and support of patients’
decisions.50
This measures reports your facility’s policy for documentation
of patient infant feeding plans and practices.
Any point
during or
post-stay
«c06respo
nse»
«c06s
core»
Employee
breastfeeding
support
The AWHONN recommends medical facilities
support all lactating employees by providing
appropriate time and facilities to express and store
milk during the work day.51 The US Breastfeeding
Committee recommends specific workplace
supports.52
This measure reports how many supports are provided to
lactating staff:
Critical supports—Room to express milk, electric breast
pump for staff use, permission to express milk on breaks;
Additional supports—On-site child care, breastfeeding
support group for staff, access to lactation consultant/
specialist, paid maternity leave other than accrued leave.
3 critical
«b13respo
nse»
«b13s
core»
Facility receipt
of free infant
formula
The ADA guidelines for mandatory elements of
infant formula HACCP plans53 apply to purchased
and free infant formula. The IOM recognizes the
inherent conflict of interest this kind of financial
support introduces.54
This measure reports whether your facility receives infant
formula free of charge from manufacturers.
No
«a25respo
nse»
«a25s
core»
Prenatal
breastfeeding
instruction
Patient education about breastfeeding improves
breastfeeding rates.20
This measure reports whether breastfeeding is a component of
prenatal patient education opportunities.
Yes
«a01respo
nse»
«a01s
core»
Coordination
of lactation
care
A designated Lactation Coordinator demonstrates
consideration of lactation support as an essential
and necessary function of intrapartum care.55
This measure reports whether your facility has a designated
person who oversees lactation care within the facility.
Yes
«b08respo
nse»
«b08s
core»
Measure
Breastfeeding
policy
How can you use this report?
This report was sent to the key leadership personnel who determine the clinical care
processes, policies, and staffing expectations at «FacName».
Consider using this report to bring personnel together to examine problematic
subscores, choose and launch improvement activities, and celebrate successes.
Example opportunities to improve infant nutrition care:
Reduce delays in first contact and breastfeeding opportunities.
Eliminate unnecessary supplementation.
Improve patient education and assistance.
Eliminate unnecessary separations between mothers and infants.
Ensure compliance with AAP clinical practice recommendations.
Facilitate staff training on breastfeeding management and support.
Improve your facility’s policies related to breastfeeding.
7
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http://bit.ly/2bgA14F
| File Type | application/pdf |
| Author | Tricia |
| File Modified | 2017-04-03 |
| File Created | 2017-02-10 |