epic breastfeeding program breastfeeding education ®

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EPIC EPIC Breastfeeding Breastfeeding Program Program Breastfeeding Education ®

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Page 1: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC EPIC Breastfeeding Breastfeeding

ProgramProgram

Breastfeeding Education

®

Page 2: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC EPIC

Educating Physicians and Practices In Educating Physicians and Practices In Their CommunityTheir Community

Began in 2007Began in 2007 Peer-to-Peer Physician Breastfeeding Peer-to-Peer Physician Breastfeeding

Education Education Patterned after the EPIC Patterned after the EPIC

Immunization ProgramImmunization Program EPIC Breastfeeding Program hopes to EPIC Breastfeeding Program hopes to

mirror it’s success mirror it’s success

®

Page 3: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC BreastfeedingEPIC BreastfeedingProgram PartnersProgram Partners

Georgia Department of Public Health Georgia Department of Public Health Georgia Chapter –American Academy Georgia Chapter –American Academy

of Pediatricsof Pediatrics Georgia Ob/Gyn SocietyGeorgia Ob/Gyn Society Georgia Academy of Family PhysiciansGeorgia Academy of Family Physicians Centers for Disease Control and Centers for Disease Control and

PreventionPrevention

Page 4: EPIC Breastfeeding Program Breastfeeding Education ®

Goals of EPIC Goals of EPIC Breastfeeding ProgramBreastfeeding Program

Educate physicians & their office staff on Educate physicians & their office staff on breastfeedingbreastfeeding

Give reasons why physicians play a critical roleGive reasons why physicians play a critical role Teach evidence - based standards on how to Teach evidence - based standards on how to

encourage, promote and support breastfeedingencourage, promote and support breastfeeding How to access lactation and support services How to access lactation and support services

in the communityin the community How to access patient education resourcesHow to access patient education resources Inform physicians of WIC services for Inform physicians of WIC services for

breastfeeding mothersbreastfeeding mothers

Page 5: EPIC Breastfeeding Program Breastfeeding Education ®

CDC Breastfeeding CDC Breastfeeding Report CardReport Card

Georgia 2007 2009 2010 2012 2013 2014

Breastfeeding Initiation

68.2% 62.5% 62.8% 70.9% 68.2% 70.3%

Breastfeeding @ 6 months

38% 36.4% 33.5% 40.8% 31.8% 40.1%

Breastfeeding@ 12 months

16.8% 18.1% 17.9% 17.6% 12.9% 20.7%

Exclusive Breastfeeding @ 6 months

11% 14.8% 9.7% 12.9% 6.2% 14.5%

Baby Friendly Hospitals

0 0 0 0 0 3

Page 6: EPIC Breastfeeding Program Breastfeeding Education ®

Why is educating Why is educating physicians on physicians on

breastfeeding important?breastfeeding important? ““[women] typically receive minimal advice [women] typically receive minimal advice

about breastfeeding from a physician.” about breastfeeding from a physician.” Freed et alFreed et al

““Physicians lack the necessary clinical skills Physicians lack the necessary clinical skills to provide lactation management” to provide lactation management” Taveras et alTaveras et al..

““Pediatricians are ideally situated to positively Pediatricians are ideally situated to positively influence the breastfeeding experiences of the influence the breastfeeding experiences of the mother and young infant.” mother and young infant.” Hillenbrand et alHillenbrand et al..

Page 7: EPIC Breastfeeding Program Breastfeeding Education ®

Challenges for Challenges for PhysiciansPhysicians

Not aware of benefits/managementNot aware of benefits/management Lack of timeLack of time Concerns about reimbursementConcerns about reimbursement Not comfortable examining breastsNot comfortable examining breasts No knowledge of community No knowledge of community

resourcesresources

Page 8: EPIC Breastfeeding Program Breastfeeding Education ®

Breastfeeding Advisory Breastfeeding Advisory GroupGroup

Eight membersEight members Meet quarterlyMeet quarterly Develop the curriculumDevelop the curriculum Annual updates to curriculumAnnual updates to curriculum Develop additional programs as needed Develop additional programs as needed Provide expert resourceProvide expert resource

Page 9: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC TrainersEPIC Trainers

Physicians, Nurses, Dieticians & Lactation Physicians, Nurses, Dieticians & Lactation ConsultantsConsultants Must be skilled with breastfeeding managementMust be skilled with breastfeeding management Complete a train the trainer education moduleComplete a train the trainer education module Can be done with group or individualCan be done with group or individual Covers curriculum, set-up, maintenance of equipment and other Covers curriculum, set-up, maintenance of equipment and other

logisticslogistics

Physicians and a lactation specialist are a team Physicians and a lactation specialist are a team and are paired to deliver the programand are paired to deliver the program

Trainers meet twice a year with the EPIC directorTrainers meet twice a year with the EPIC director Trainers receive feedback and evaluations of their performanceTrainers receive feedback and evaluations of their performance Discuss any updates and offer suggestions for curriculum changesDiscuss any updates and offer suggestions for curriculum changes

Trainers are given modest stipend and travel Trainers are given modest stipend and travel reimbursementreimbursement

Page 10: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC ProgramEPIC Program One hour EPIC Breastfeeding Program One hour EPIC Breastfeeding Program Delivered through PowerPoint Presentation Delivered through PowerPoint Presentation

with scriptwith script Presented inPresented in

Doctors officeDoctors office HospitalsHospitals Residencies Residencies Health Departments/WIC Health Departments/WIC

Goal is 6 programs a monthGoal is 6 programs a month Resource materials are left behind for the office Resource materials are left behind for the office

to encourage, promote & support breastfeedingto encourage, promote & support breastfeeding

Page 11: EPIC Breastfeeding Program Breastfeeding Education ®

ResourcesResources

Each office or program receives Each office or program receives breastfeeding resourcesbreastfeeding resources

BooksBooks HandoutsHandouts Coding informationCoding information WIC informationWIC information List of community List of community

resourcesresources

Page 12: EPIC Breastfeeding Program Breastfeeding Education ®

Target CountiesTarget Counties

Bibb Bibb LaurensLaurens RichmondRichmond ClaytonClayton DeKalbDeKalb FultonFulton CobbCobb ThomasThomas GwinnettGwinnett MuscogeeMuscogee ChathamChatham

Page 13: EPIC Breastfeeding Program Breastfeeding Education ®

Marketing our ProgramMarketing our Program

GA AAP Board meetingsGA AAP Board meetings BlastfaxesBlastfaxes Exhibiting at conferencesExhibiting at conferences Send out mailings to previous program Send out mailings to previous program

recipients to take a different programrecipients to take a different program Trainers and Advisory members encourage Trainers and Advisory members encourage

programsprograms Close ties with the WIC and Health Close ties with the WIC and Health

DepartmentsDepartments Word of MouthWord of Mouth

Page 14: EPIC Breastfeeding Program Breastfeeding Education ®

EvaluationEvaluation Pre-program surveyPre-program survey

Assessing physician knowledge and practicesAssessing physician knowledge and practices Program surveyProgram survey

Participant evaluation formParticipant evaluation form Evaluate curriculumEvaluate curriculum Evaluate trainer effectiveness Evaluate trainer effectiveness Seek areas of interestSeek areas of interest

Post- program survey (60 day F/U)Post- program survey (60 day F/U) Access program quality and contentAccess program quality and content Access knowledge gainedAccess knowledge gained Changes in practice behaviorChanges in practice behavior

Page 15: EPIC Breastfeeding Program Breastfeeding Education ®

EPIC Breastfeeding EPIC Breastfeeding ProgramsPrograms

““Breastfeeding Fundamentals”Breastfeeding Fundamentals”

““Supporting Breastfeeding in the Supporting Breastfeeding in the Hospital Setting”Hospital Setting”

““Advanced Breastfeeding Support”Advanced Breastfeeding Support”

®

Page 16: EPIC Breastfeeding Program Breastfeeding Education ®

Breastfeeding Breastfeeding FundamentalsFundamentals

Challenges for PhysiciansChallenges for Physicians Realistic expectationsRealistic expectations Racial disparitiesRacial disparities

Benefits of breastfeedingBenefits of breastfeeding LatchLatch

PositioningPositioning Milk transferMilk transfer

Page 17: EPIC Breastfeeding Program Breastfeeding Education ®

FundamentalsFundamentals

Breastfeeding at deliveryBreastfeeding at delivery Prenatal visit (emphasis on the OB’s Prenatal visit (emphasis on the OB’s

role)role) Postpartum routinePostpartum routine

Most common problemsMost common problems Sore nipplesSore nipples MastitisMastitis Maternal emotionsMaternal emotions MedicationsMedications

Page 18: EPIC Breastfeeding Program Breastfeeding Education ®

FundamentalsFundamentals

Hot TopicsHot Topics Co-sleepingCo-sleeping Milk sharingMilk sharing PacifiersPacifiers SupplementingSupplementing ContraceptionContraception Starting solidsStarting solids

QuestionsQuestions

Page 19: EPIC Breastfeeding Program Breastfeeding Education ®

Supporting Supporting Breastfeeding in the Breastfeeding in the

HospitalHospital Benefits of breastfeedingBenefits of breastfeeding Obstacles to breastfeedingObstacles to breastfeeding

Baby FriendlyBaby Friendly 10 steps10 steps PolicyPolicy Joint commission and mPINC scoresJoint commission and mPINC scores

After deliveryAfter delivery Skin to skinSkin to skin Exclusive breastfeedingExclusive breastfeeding DocumentationDocumentation

Page 20: EPIC Breastfeeding Program Breastfeeding Education ®

Hospital ProgramHospital Program Separation of mom and babySeparation of mom and baby

Pumping/hand expressionPumping/hand expression Kangaroo Care/NICUKangaroo Care/NICU

BarriersBarriers Discharge bagsDischarge bags Follow-up and supportFollow-up and support

WICWIC Food packagesFood packages Services for breastfeeding mothersServices for breastfeeding mothers

Community ResourcesCommunity Resources

Page 21: EPIC Breastfeeding Program Breastfeeding Education ®

Advanced Breastfeeding Advanced Breastfeeding SupportSupport

How do you know if a mother is producing How do you know if a mother is producing enough milk?enough milk? Breast changesBreast changes Urine and stool outputUrine and stool output

How can a mother increase her milk supply?How can a mother increase her milk supply? Evaluating a feedingEvaluating a feeding Pumping/hand expressionPumping/hand expression Galactogues/medicationsGalactogues/medications

What can mothers do to prevent or treat sore What can mothers do to prevent or treat sore nipples?nipples? LATCHLATCH EngorgementEngorgement Nipples problemsNipples problems

Page 22: EPIC Breastfeeding Program Breastfeeding Education ®

Advanced ProgramAdvanced Program When supplements are indicated, how does a When supplements are indicated, how does a

mother supplement without interfering with mother supplement without interfering with breastfeeding?breastfeeding? Maternal issuesMaternal issues Infant factorsInfant factors When to supplementWhen to supplement

WhenWhen HowHow MethodsMethods

How does the pre-term infant differ in their ability How does the pre-term infant differ in their ability to breastfeed?to breastfeed? Define pre-term infantDefine pre-term infant Feeding issuesFeeding issues

Page 23: EPIC Breastfeeding Program Breastfeeding Education ®

ResultsResults

548 programs548 programs 1,590 physicians trained1,590 physicians trained 24.3% are physicians24.3% are physicians 6,889 total trained6,889 total trained 29% held in focus counties29% held in focus counties 99.3% of practices would recommend 99.3% of practices would recommend

the training to other physiciansthe training to other physicians

Page 24: EPIC Breastfeeding Program Breastfeeding Education ®

Future ideas of EPIC®Future ideas of EPIC®

Three hour hospital curriculumThree hour hospital curriculum NICU curriculumNICU curriculum Infant feeding curriculumInfant feeding curriculum More emphasis on OB’s and More emphasis on OB’s and

breastfeeding support/WIC referralsbreastfeeding support/WIC referrals Need more physician data on Need more physician data on

breastfeeding ratesbreastfeeding rates Working with businesses to set up Working with businesses to set up

lactation roomslactation rooms

Page 25: EPIC Breastfeeding Program Breastfeeding Education ®

Questions?Questions?