Increasing the Exclusivity of Breastfeeding in the Postnatal Hospital Period: A Quality Improvement Initiative

Background: Supplementing infants with formula in the postnatal hospital period can impact the exclusivity and duration of breastfeeding. As a result, the mother-infant dyad will be less likely to receive the protective health benefits of exclusive breastfeeding.

Local Problem: In a rural community hospital, approximately 91% of mothers initiated breastmilk feedings; however, only 43% of those mothers were able to exclusively breastfeed in the postnatal period and 38% of breastfed infants received formula supplementation.

Methods: This quality improvement project was guided by Lewin’s Theory of Change to implement evidence-based recommendations to increase exclusive breastfeeding. Evaluation methods included a chi-square analysis on infant feeding statistics, a paired t-test on breastfeeding knowledge assessments, and qualitative statistics on the AIM-IAM-FIM survey.

Interventions: The project lead implemented an evidence-based nurse education package, signage to reinforce the 10 Steps to Successful Breastfeeding, and breastfeeding policy recommendations.

Results: There was an overall decrease in the number of infants supplemented with formula from 38% to 33% after the project was implemented. This demonstrated clinical significance as five additional infants were exclusively breastfed compared to the previous year’s data. Breastfeeding knowledge in nurses improved and this was statistically significant (p=0.04). Staff rated the project as acceptable, implementable, and feasible.

Conclusion: The project aimed to increase exclusive breastfeeding and decrease formula supplementation rates during the postnatal hospital period. The analysis of this project demonstrated statistical and clinical significance. More evidenced-based interventions need to be in place to better prepare mother-baby nurses to support exclusive breastfeeding.