I happy to hear others are starting to look at this.

In terms of how we calculate Measure 5 (haven't started on 5a yet).  We are fortunate enough to have a EMR system that our clinical educator can configure to collect data in real time.  So I am able to look at all infant feeds instead of a random sampling which is also an acceptable means.  Our system culls all of the moms that breastfeed exclusively (that's my numerator), the denominator is all infants minus those who have a JC reason to be excluded (NICU admit, galactosemia, HIV, Foster care, Illicit drug use, etc).  

In looking at 5a I think what I will be adding to the exclusion list will be anyone who cites bottle (or I guess both grr) on admit.  

What I hope in looking ahead is that our EMR systems will be configured to collect those numbers for us.  That is what *should* happen.  I also think QI will be used as data extractors to do a random sampling, it will be important that exclusions are well documented, because as we know..many do not really *get* lactation..what we do and why we do it.  

We currently use the customized GE system for our maternal child system EMR.  We have been told that we will be switching to Cerner in the next year or so.  So it will be back to the drawing board for us. ugh.

Which reminds me I need to get myself on that committee..

Denise Bulpitt RN BSN IBCLC
St. Vincent's Medical Center
Bridgeport, Ct.    

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