Thanks,  I'm very familiar with the toolkit, some of our data collections tools were used as examples :)

Yet even in the updated toolkit, there are no specific guidelines on how to collect 5a.

For instance, I could understand excluding everyone who was admitted adamantly formula feeding.  But what about those who are doing "both" or want to "try" it and then after skin to skin they decided against it?

I've been using our increasing exclusivity stats as a means of driving change.  I'm happy to report it's working.  When our director of pediatrics read the TJC exclusive bf core measure, he set out some nice strict guidelines about NOT supplementing infants who do not need it.  It was also nice to show our staff, especially the night staff...that because of all their teaching and hard work our exclusivity stats (using TJC criteria) had gone from 27% to 60% in the past year.  

I see 5a muddying those waters quite a bit.  

-Denise Bulpitt RN BSN IBCLC
 

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