Across the U.S., obstetric units in rural hospitals have been peril. More than 90 have closed since 2015, and by 2020, the American Hospital Association said half of rural community hospitals didn’t provide obstetric care. In addition, a study of hospital administrators carried out before the pandemic found 20% of them said they did not expect to be providing labor and delivery services in five years’ time.
At Siler City’s UNC Chatham Hospital, staff are working to keep the facility open, running at full operation, and providing service at a high level. This week, we speak with Kristen Coleman, the manager of the hospital’s Maternity Care Center, about its efforts to become designated as “Baby-Friendly.”
A Siler City native, Coleman began work at the hospital in 2019 as the MCC’s project manager/unit manager. “Nursing in labor and delivery has always been a passion of mine, even in high school,” she said. “To see this come back to my home community where there is a great need for the service is a dream come true. I personally try to speak with every person who delivers at Chatham and some of them I even know on a personal level.”
What does the “Baby-Friendly” hospital designation signify for Chatham Hospital, and why is it so prestigious? Why is it a worthy goal?
When we obtain this designation it supports the evidence-based practice care that we give at Chatham. There is a sense of pride from all staff as this is no easy accomplishment. This puts Chatham on a national list and further lets the nation know that we support baby-friendly in our hospital and are giving top-notch care.
At this point, the hospital has passed two phases — Discovery and Development. What was involved in passing the “Discovery” phase?
The Discovery phase was the easiest. We had to simply make the decision, obtain a letter from the CEO of hospital supporting the decision and collect our current data on breastfeeding at Chatham.
And what about the “Development” phase?
The Development phase was a little challenging with multiple steps; it took almost a whole year. This is where all the planning and thinking came in.
Charlotte Zuber-Patton, our lactation consultant, did the bulk of the work. We had to develop a multidisciplinary team, an overall work plan, breastfeeding friendly policies, a staff training plan, prenatal teaching plans, postpartum teaching plans, and a data collection plan.
What two phases remain, then, and what’s the strategy and timeline for achieving them?
Dissemination and Designation are the two remaining phases. The Dissemination phase is where all the hard work from the Development phase is put into play. We will train all the staff and implement the plans and policies that we developed. We are still collecting data during this phase as well to show all of our hard work that we have been doing. This phase has to be completed in 10 months, so we should be finished with this phase by September 2023.
Designation is the next step, but also the most nerve-wracking. In the Designation phase we continue to audit our practices, review the data and compare those results to the criteria for the designation. There is a readiness interview that is conducted over the phone to see if we are ready for the designators to come on site and assess, if we are not they provide us with the needed tools to become ready, we move on those task and then have the interview again.
Once the phone interview is successful and we are ready, they come on-site for an assessment. The on-site visit is a team that assesses the unit and all of our hard work, they compose a report and then it goes to an external review board to determine if we have fully implemented the needed criteria. All of this needs to be completed within eight months of moving into the Designation phase.
We hope to be Baby-Friendly Designated by summer of 2024.
How is your team involved in the work required to make it happen? And are there any lessons or experiences gained from the work that have particularly made the Maternity Care Center better?
The bulk of the work is done by Charlotte, and myself; however, all staff have to be trained and know the ins and outs of the initiative.
We know there’s been much discussion about the Maternity Care Center and its future, given staffing shortages and use. Can you share an update about the MCC’s operation and what you think the future holds?
The Maternity Care Center will return to full 24/7 operations on March 25. We are very excited about this and hope patients will continue to use this much needed service that is close to home. The staff in the department are well trained and often run simulations in the department to assure that current practices flow well and are successful. I think the future is bright and my goal is to double our current number of deliveries by December 2023.
Why should expectant mothers feel confident about Chatham Hospital and the MCC?
All staff are trained in labor and delivery emergencies. Some staff have taken the Advanced Life Support in Obstetrics course to better prepare, with a goal of all staff to be trained by 2024. This is a very intense course with hands-on activities and video training in emergency situations. Most of our providers also attend deliveries at UNC Main campus, with whom we have a great working relationship with.
Our patient satisfaction scores are consistently 99% and above. We strive for patient centered care that involves the nurse and provider listening to the patient’s wishes for their delivery, including going above and beyond on expectations.
Coleman can be reached at Kristen.firstname.lastname@example.org
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