Brenda writes "We are wondering if hospitals who have chosen exclusive breastfeeding as a core measure are running into any problems with JHACO when the reasons for supplementation of formula are related to the infant, as in the case of excessive weight loss, hypoglycemia and jaundice, when mother is unable or cannot provide her own EBM? We ask this question because JHACO does not list medical reasons for the infant in the list above. Thank you!"
I believe there are a few infants that can be excluded, if I'm remembering correctly, such as those with galactosemia and PKU. However, since those conditions are not diagnosed during the maternity hospitalization period, they would not be excluded at that time. My understanding was that this core measure is not optional. Is it optional? I didn't know that. I thought it was mandatory. JHACO did publish a document to providers about the core measure, check in guidelines and see if there are infants that you can exclude from your denominator. But otherwise all couplets must be included unless the mother or infant falls into one of the categories that you mentioned. You put all the non-excluded couplets into the denominator, then the number of exclusively breastfed in the numerator, and then calculate your percentage.
The purpose of this core measure is that JHACO is hoping that nurses and physicians realize that many of these situations in which they thought formula supplementation was necessary, are not, its just what we are used to doing. They are telling us that research says it's not necessary to always supplement with formula and what we are doing is not in the best health of the infant and they would like for us to at least make some attempt to try improving breastfeeding management first, then try to give them EBM, and then lastly supplement with formula, but only after trying to make every attempt to give exclusive breastmilk feedings. Formula should be the last thing we do, not the first.
The situations that you mentioned are the exception rather than the rule. If we have good breastfeeding management from the beginning it will be even rarer. And when we have those situations occur, such as hypoglycemia, you may find that by having the mother hand express some colostrum and spoon feeding to the infant, most of the time the blood sugar rises well. When it doesn't, then the provider will need to decide whether to give some supplemental formula, but I think that will be fairly rare, but in those cases you can't count them as exclusively breastfed. The better we get at this, the more you will see your numbers increase.
Is anyone else having the problem that instead of talking about how we can increase exclusive breastfeeding rates, some managers talk to you about how we can fudge the numbers? A friend of mine told me that this was the focus of a meeting with her manager this week. I'm fortunate that my director and manager and both really pro-breastfeeding and see this as an opportunity to improve our exclusive breastfeeding rate, but I hear that's not true for everyone. That's unfortunate.
Sincerely,
Tricia Shamblin, RN, IBCLC
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