The 'comprehensively' in clOUDi - more than forms and policies...
In these challenging healthcare times it is not easy to find the time and create the team necessary to lead the culture change necessary to make quality improvement initiatives successful. In clOUDi the PQCNC membership has chosen to work on a complex but vital healthcare concern. Supporting mothers dealing with substance use disorder and collaborating with mothers as the best possible medicine for their babies is a straight up challenge to the culture of bias which exists to some degree in all of our facilities. In order to achieve the ambitious goals we have set, maternal and newborn QI leaders need to develop a coordinated local action plan that will detail activities that can be tested and evaluated in step wise fashion as we move towards accomplishing the clOUDi mission.
This paper describes a remarkable effort to increase rates of use of mom’s milk for babies at risk for NAS. This is a critical driver in the clOUDi action plan for care on newborns, but it is equally important for maternal care. Empowering mothers to be the source of nutritional support for their babies will build the trusting and respectful relationship that can sustain mother’s on their recovery journey. The investigators in this paper were able to increase the usage rate of mothers’ own milk (MOM) among neonates with prenatal opioid exposure from a baseline average of 47% to an average of 75% over two years!
The authors description of their journey is a textbook display of QI science at work. Over time multiple small interventions were employed, tracked, and new interventions planned and executed, until the intended goalwas reached.
In our clOUDi journey their may be a temptation to believe that introducing a validated verbal screening form into the EMR will signify victory. It is a critical step but a first step on the road to creating a culture of collaboration and empathy with mothers dealing with the challenges of substance use. If all we do is check the validated verbal questionnaire box, and do not work to implement changes that will create a culture of collaboration, how many mothers will disclose their substance use? How many will accept a referral for treatment.
Many of us are hard at work attempting to make validated screening part of our practice. Do not lose sight of the fact that this is a QI project with a long road ahead. If clOUDi is to be successful, we need to see moms with substance use disorder as women we have a duty to serve, and we need to create a culture that knows these moms are the best possible medicine for their babies. This will only happen if we are willing to open pour hearts, apply our clinical expertise and use the principles of QI so well described in the work of Shukla et al.
Together we can make this happen!
