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pdfDEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30341-3724
DATE
NAME
TITLE
ADDRESS 1
ADDRESS 2
CITY, STATE ZIP
Dear NAME:
The Centers for Disease Control and Prevention (CDC) recently conducted the first national assessment
of Maternity Practices in Infant Nutrition and Care, known as the mPINC Survey. We thank you for
participating in the survey; your involvement was vital to its success.
Your hospital’s participation in this national initiative reflects your commitment to continuous quality
improvement. Your hospital was one of 2,672 birth facilities that responded to the survey, comprising
82% of all hospitals and birth centers nationwide that provide maternity services. Detailed information
about the survey, including scoring, rationale, and an article describing state and national results, can be
found at www.cdc.gov/mpinc .
The enclosed Benchmark Report provides a summary of breastfeeding-related maternity care practices
and policies within your hospital, compared with other hospitals and birth centers across the country. In
addition to highlighting practices and policies on which your hospital scored well, the Benchmark Report
also indicates your hospital’s opportunities for quality improvement.
There are many strategies to improve maternity care practices and policies (visit our website at
www.cdc.gov/breastfeeding for more information). This Benchmark Report is one tool you can use to
identify specific practices and policies in your hospital that can be changed to be fully supportive of
breastfeeding.
Thank you again for your dedication to quality improvement in this critically important area of health care
delivery. If you have any questions, please feel free to contact us at [email protected] for assistance.
Sincerely,
Laurence M. Grummer-Strawn, MPA, MA, PhD
Chief, Nutrition Branch
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Enclosure
cc:
Hospital Administrator/Chief Executive Officer
Director of Hospital Quality Improvement
Obstetrics Medical Director
Pediatrics Medical Director
Nurse Manager for Mother Baby Services
Survey Respondent
Maternity Practices in Infant Nutrition and Care—mPINC
Quality Practice Measures
Benchmark
Report
2009 Survey
Fake Medical Center
123 Street Road
Any City, ST 99999
Facility ID: H99999
National Center for Chronic Disease Prevention and Health Promotion
Division of Nutrition, Physical Activity, and Obesity
2009 Quality Practice Measures
Summary Information
Fake Medical Center’s
Composite Quality
Practice Score:
What is the
mPINC Survey?
71
The Maternity Practices in Infant Nutrition and Care (mPINC) Survey is a national survey of infant
feeding practices that provide maternity care services.
The Battelle Centers for Public Health Research and Evaluation first conducted this survey for the
Centers for Disease Control and Prevention between August and December 2007, and again
between August and December 2009.
Fake Medical Center’s
Composite Quality Practice Score Percentilesi
United States 65
(Among all facilities nationwidei)
Kansas 83
(Among all facilities in Kansas)
Similar Size Facilities
(Among all US facilities with 63
1000‐1999 births per year )
ii
0
100
Fake Medical Center reported 1100 births in the past year; it is in the size category of 1000‐1999 births per
year.
1
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).
What’s in this report?
Fake Medical Center’s results from the 2009 CDC
mPINC Survey—CDC provides this resource to help
you improve outcomes by providing the best evidencebased care to your patients.
Summary Information—Examine your Composite
Quality Practice Score.iii Scores range from 0 to 100;
your score compares to all other facilities: across the
US; in your state; and in your size category
nationwide.ii
Care Dimension Information—Learn about your
subscoresiv and percentiles in: labor and delivery
care; postpartum feeding of breastfed infants,
breastfeeding assistance, and contact between
mother and infant; staff training; and structural and
organizational aspects of care delivery.
Accompanied with each score are explanations of
how and why CDC chose to measure these
particular practices.
Who responded to the mPINC Survey?
All facilities that provide intrapartum care in the United
States and Territories received the mPINC survey.
At each facility, surveys were completed by the person most
knowledgeable about the care processes and policies
involved in feeding healthy infants.
The survey response rate was 82%.
Maternity Care Practices
and 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.
Components of
infant feeding care
best practices
The following key clinical care processes,
policies, and staffing expectations are
appropriate for care of all perinatal
patients, unless medically contraindicated:
I. Labor and delivery care—Upon
delivery,v the newborn is placed skinto-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—
Assistance is offered to the
breastfeeding mother and infant using
consistent standards for supportive
patient education and assessment;
c. Contact between mother and
infant—The infant is enabled 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; 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 appropriate breastfeeding
skills training and assessment.
V. Structural and organizational
aspects of care delivery—Best
practices policies are implemented
for staffing, care process, and
communication expectations in
perinatal patient education and care
settings; are supportive of
breastfeeding employees; and are
free from financial conflict of
interest.
iii The
Composite Quality Practice Score is a simple average of subscores from each care dimension.
care dimension subscore is the calculated simple average of scored items within each dimension.
v 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.
iv The
2
Subscore Percentiles:
I. Labor and Delivery
Care
Subscore:
68
United States 54
Kansas 78
Similar Size Facilities 58
0
Measure
Initial skin-toskin contact
Ideal
Response
Your
Response
Your
Score
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
Many
70
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
Many
70
This measure reports what percent of patients have the
opportunity to breastfeed within 1 hour of uncomplicated
vaginal birth.
≥90
85
70
≥90
95
100
Almost
always
Sometimes
30
Rationale
Skin-to-skin contact improves infant ability to
establish breastfeeding.9
100
Explanation
Initial
breastfeeding
opportunity
Early initiation of breastfeeding increases overall
breastfeeding duration and reduces a mother’s risk
This measure reports what percent of patients have the
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
opportunity to breastfeed within 2 hours of uncomplicated
Cesarean birth.
This measure reports how often patients have routine infant
procedures performed while mother and infant are skin-toskin.
Subscore Percentiles:
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.
3
Subscore:
75
United States 36
Kansas 46
Similar Size Facilities 30
0
100
Ideal
Response
Your
Response
Your
Score
This measure reports what percent of breastfeeding infants
receive breast milk as their first feeding after uncomplicated
vaginal birth.
≥90
95
100
This measure reports what percent of breastfeeding infants
receive breast milk as their first feeding after uncomplicated
Cesarean birth.
≥90
95
100
This measure reports what percent of breastfeeding infants
receive non-breast milk feedings.
<10
5
100
This measure reports whether breastfeeding infants receive
glucose water and/or water.
No
Yes
0
Explanation
Subscore Percentiles:
II. Postpartum Care—
b. Breastfeeding Assistance
Subscore:
96
United States 84
Kansas 91
Similar Size Facilities 82
0
Measure
Documentation
of feeding
decision
Breastfeeding
advice and
counseling
Explanation
Ideal
Response
Your
Response
Your
Score
This measure reports how often infant feeding decisions are
documented in medical records.
Almost
always
Almost
always
100
Most
Most
100
This measures reports how many patients are taught to
recognize and respond to infants’ cues instead of feeding on
a set schedule.
Most
Most
100
This measure reports how often breastfeeding patients
receive instructions to limit suckling at the breast to a
specific length of time.
Rarely
Rarely
100
This measure reports how many patients received a directly
observed breastfeeding assessment by facility staff.
Most
Most
100
Standardized breastfeeding assessment tools
This measure reports whether breastfeeding is assessed
improve comparability and validity of findings.23-25 using a standardized or adapted assessment tool.
Yes
Yes
100
In-hospital pacifier use reduces duration of
exclusive breastfeeding.26
Few
Some
70
Rationale
Standard documentation of infant feeding
decisions is important in order to adequately
support maternal choice.18
The AAP recommends pediatricians provide
parents with complete, current information on the
This measure reports how many patients who are
benefits and methods of breastfeeding to ensure
breastfeeding, or intend to breastfeed, are provided advice
that the feeding decision is a fully informed one.19 and instructions about breastfeeding.
Patient education is important in order to establish
breastfeeding.20,21
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
Pacifier use
100
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 breastfeeding patients are
given pacifiers by facility staff.
Subscore Percentiles:
II. Postpartum Care—
c. Contact Between
Mother and Infant
Subscore:
Measure
Rationale
Separation of
mother and
newborn during
transition to
receiving units
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
Patient
rooming-in
Rooming-in of mother-infant pairs increases infants’
opportunities to learn to breastfeed28 and increases
duration and quality of maternal sleep.29
Instances of
mother infant
separation
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
40
United States 6
Kansas 18
Similar Size Facilities 18
0
100
Ideal
Response
Your
Response
Your
Score
This measure reports how many minutes motherinfant pairs are separated after uncomplicated vaginal
births during the transition from labor and delivery
care to their receiving patient care units.
No
separation
75
30
This measure reports how many hours breastfeeding
mother-infant pairs are separated at night.
No
separation
No
response
‐‐‐
This measure reports what percent of mother-infant
pairs room together ≥23 hrs per day.
≥90
5
0
0
6
30
Most
Most
100
Explanation
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.
4
Subscore Percentiles:
III. Facility Discharge
Care
Subscore:
100
United States 93
Kansas 96
Similar Size Facilities 95
0
Measure
100
Ideal
Response
Your
Response
Your
Score
All 3 modes
All 3
modes
100
No
No
100
Ideal
Response
Your
Response
Your
Score
This measure reports how many hours of
breastfeeding education new nurses and other birth
attendants* receive.
≥18
1 to 3
25
This measure reports how many hours of
breastfeeding education current nurses and other birth
attendants* receive.
≥5
1 to 2
50
This measure reports how many nurses and other
birth attendants* received any breastfeeding education
in the past year.
Most
Most
100
At least once
a year
Less than
once a
year
50
Rationale
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;
33
to assess breastfeeding. Ensuring post discharge
Referral—Providing information about:
ambulatory support improves breastfeeding
Available phone numbers, support groups, lactation
34-35
outcomes.
consultant/specialist, WIC, outpatient clinics.
Distribution of
“discharge
packs”
containing
infant formula
The AAP and ACOG recommend against
distributing infant formula “discharge packs”14,36
because it reduces exclusive breastfeeding rates
and implies health care professional endorsement
of specific commercial items.37-39
This measure reports whether breastfeeding patients are
given “discharge packs” containing product marketing
infant formula samples.
Subscore Percentiles:
IV. Staff Training
Subscore:
56
United States 50
Kansas 48
Similar Size Facilities 40
0
Measure
Preparation of
new staff
Continuing
Education
Supplementary
feedings
Rationale
Staff training ensures standard capacity to provide
evidence-based care, learn about new information, and
maintain patient support skills.39-42 Standard 18 hour
staff training improves patient breastfeeding outcomes
facility-wide.43,44
Explanation
Like other critical nursing competencies, regular
This measure reports how often nurses and other
birth attendants* are assessed for competency in
assessment of competency in breastfeeding
management and support improves delivery of care.45-47 breastfeeding management and support.
* In free-standing birth centers, these questions were asked among
“birth attendants” to accommodate the range of attendants to births in
these facilities.
5
100
Subscore Percentiles:
V. Structural & Organizational
Aspects of Care Delivery
Subscore:
62
United States 30
Kansas 34
Similar Size Facilities 14
0
Measure
Breastfeeding
policy
Ideal
Response
Your
Response
Your
Score
10
7
70
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
Both
modes
100
This measures reports your facility’s policy for
documentation of patient infant feeding plans and practices.
Any point
during or
post-stay
At
admission
only
25
3 critical
1 critical,1
additional
40
Rationale
The AAP recommends inclusion of specific
elements in facility breastfeeding policies.14 The
Academy of Breastfeeding Medicine’s clinical
protocol lists components of a model
breastfeeding policy.16
Effective intra-professional communication
Communication
increases the likelihood that a facility’s
of breastfeeding
breastfeeding policy will be implemented
policy
appropriately.48,49
100
Explanation
This measure reports the number of model breastfeeding
policy elements in your facility’s breastfeeding policy.
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
Employee
breastfeeding
support
This measure reports how many supports are provided to
The AMA and AWHONN recommend medical
lactating staff:
facilities support all lactating employees by
Critical supports—Room to express milk, electric breast
providing appropriate time and facilities to express
pump for staff use, permission to express milk on breaks;
51,52
The US
and store milk during the work day.
Additional supports—On-site child care, breastfeeding
Breastfeeding Committee recommends specific
support group for staff, access to lactation consultant/
53
workplace supports.
specialist, paid maternity leave other than accrued leave.
Facility receipt
of free infant
formula
The ADA guidelines for mandatory elements of
infant formula HACCP plans54 apply to purchased
and free infant formula. The AMA recognizes the
inherent conflict of interest this kind of financial
support introduces.55,56
This measure reports whether your facility receives infant
formula free of charge from manufacturers.
No
Yes
0
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
Yes
100
This measure reports whether your facility has a designated
person who oversees lactation care within the facility.
Yes
Yes
100
A designated Lactation Coordinator demonstrates
Coordination of
consideration of lactation support as an essential
lactation care
and necessary function of intrapartum care.57
Next Steps
Example
Improvement
Opportunities
Examine the care dimension that was the most problematic at Fake Medical Center compared
to others in Kansas or across the country, and choose one care process or policy to begin
improving.
I. Labor and delivery care—Reduce delays
in first contact and breastfeeding
opportunities.
II. Postpartum care:
a. Feeding of breastfed infants—Eliminate
unnecessary supplementation;
b. Breastfeeding assistance—Improve
patient education and assistance; and
c. Contact between mother and infant—
Eliminate unnecessary separations
between mothers and infants.
III. Facility discharge care—Ensure compliance
with AAP clinical practice recommendations.
IV. Staff training—Facilitate staff training on
breastfeeding management and support.
V. Structural and organizational aspects of care
delivery—Improve your facility’s policies
related to breastfeeding.
6
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For more information visit:
www.cdc.gov/mpinc
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and
Health Promotion
Centers for Disease Control and Prevention
Atlanta, GA USA
March 2011
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