The Baby-Friendly Hospital Initiative at Norton Women’s & Kosair Children’s Hospital

Breastfeeding can have a lifelong impact on a child, offering  protection from respiratory and gastrointestinal illness, childhood leukemia and lymphoma. It also protects children from obesity, diabetes and inflammatory bowel disease as they grow. Benefits to the mother include accelerated recovery from birth, reduced stress and faster weight loss after pregnancy. The U.S. could save billions of dollars per year on health care costs if 90 percent of mothers breastfed their babies exclusively for six months. The American Academy of Pediatrics estimates that higher breastfeeding rates would save up to $13 billion per year in sick care visits, prescriptions and hospitalizations.


 As the first designated Baby-Friendly hospital in the Louisville area, Norton Women’s &
Kosair Children’s Hospital will contribute to improving Kentucky’s breastfeeding rates and the overall health of our state.



Norton Women’s & Kosair Children’s Hospital is dedicated to providing quality health care to those we serve by focusing on the unique needs of women and children in our communities. As part of our commitment to promoting and supporting breastfeeding, Norton Women’s &
Kosair Children’s Hospital embarked on the Baby-Friendly Hospital Initiative in 2012. The journey culminated with the Baby-Friendly On-site Assessment on Aug.17 and 18, 2015, and we achieved full designation the following October. The multidisciplinary team at Norton Women’s & Kosair Children’s Hospital has worked to create an environment to support successful breastfeeding by changing policies and procedures and increasing the knowledge and skills of our health care workers.


The Baby-Friendly Hospital Initiative is a global program launched in 1991 by the World Health Organization and the United Nations Children’s Fund to encourage and recognize hospitals and birthing centers that offer optimal care for infant feeding. Becoming a Baby-Friendly facility required a comprehensive, detailed and thorough journey toward excellence in evidence-based maternity care with the goal of optimal infant feeding. Baby-Friendly helps hospitals give all mothers the information, confidence and skills necessary to breastfeed their babies or feed safely with formula. Baby-Friendly promotes, protects and supports breastfeeding through its Ten Steps to Successful Breastfeeding:


  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

  2. Train all health care staff in the skills necessary to implement this policy.

  3. Inform all pregnant women about the benefits and management of breastfeeding.

  4. Help mothers initiate breastfeeding within one hour of birth.

  5. Show mothers how to breastfeed and maintain lactation, even if they are separated from their infants.

  6. Give infants no food or drink other than breast milk, unless medically indicated.

  7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.

  8. Encourage breastfeeding on demand.

  9. Give no pacifiers or artificial nipples to breastfeeding infants.

  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.


According to national statistics, Kentucky has one of the lowest breastfeeding rates in the country. In 2012, only 59.4 percent of Kentucky’s  total infant population was breastfed, according to the Centers for Disease Control and Prevention. This incidence rate is significantly lower than the goal of 81.9 percent set by Healthy People 2020, a national health promotion initiative.


1. American Academy of Pediatrics. Policy statement: Breastfeeding and the use of human milk. Pediatrics. 2012;129(3), e827-e841. doi:10.1542/peds.2011-3552

2. Baby-Friendly USA Inc. staff. Guidelines and evaluation criteria for facilities seeking baby-friendly designation. Baby-Friendly USA Inc.: The Gold Standard of Care. file:///Users/css7/Downloads/2010_Guidelines_Criteria_Rev_11_28_11.pdf. Published June 10, 2010.

3. Baby-Friendly USA: The Gold Standard of Care. Accessed October 2015.

4. Centers for Disease Control and Prevention. Breastfeeding report card — United States, 2012.

5. Schanler R. Maternal and Economic Benefits of Breastfeeding. UpToDate. Published Sept. 16, 2014.

Mary Kelley, R.N., delights in providing high-quality care to her patients.

Comprehensive stroke care certification at Norton Brownsboro Hospital

Jennifer Clements, R.N., BSN, checks on one of her stroke patients.

Norton Healthcare’s stroke care program is known for setting lofty goals, and in 2015 one of the biggest goals for stroke care was realized. Five years in the making, Norton Brownsboro Hospital was surveyed for The Joint Commission’s certification as a Comprehensive Stroke Center (CSC). The program undertook major process implementation and improvement strategies to meet the standards in care and resources to satisfy the requirements for the certification. The multidisciplinary approach required many new processes in all areas involved in the care of patients with stroke. For the nursing staff at Norton Brownsboro, this meant building best practices from across the country into the day-to-day care of patients admitted with stroke.


Many of the process improvement efforts were concentrated around nursing assessment of complex stroke patients, including depression assessment, frequent neurological assessment after mechanical interventions and carotid procedures, and care of aneurysmal subarachnoid and intracranial hemorrhages. Complex stroke cases touch many care areas; therefore, nurses in the Emergency Department, operating rooms, neurological team, post-anesthesia care unit, intensive care unit and on 3W had to become experts in the care of complex stroke. This called for an increase in the stroke education provided at Norton Brownsboro. Resources used included classes such as “Care of the Complex Stroke Patient,” "Neuropharmacology" and others. Stroke rounds were also started with the Clinical Nurse Specialist and Stroke Coordinator, Lindsey Siewert MSN APRN CCNS CCRN-K, to answer questions, ensure metrics are met and be a resource to the staff caring for stroke patients.


Every new process that was implemented affected the nursing staff, who knew that the processes would lead to the best care for their patients. The Norton Brownsboro staff embraced the stroke program from the beginning and ultimately led us to the day of the survey for Comprehensive Stroke Care certification.


The two-day survey was intense but very rewarding. We were able to obtain ideas from the surveyors to make the stroke program even stronger. Nursing stepped up to the plate to articulate and demonstrate the exceptional care given to the stroke patients at Norton Brownsboro Hospital based on best practices implemented throughout previous years.



Improving surgical care through the Enhanced Recovery After Surgery program

In early 2015, Norton Audubon Hospital embarked on a mission to improve outcomes in our surgical patients by implementing the Enhanced Recovery After Surgery (ERAS) program. ERAS is a multimodal, multidisciplinary care pathway designed to achieve early recovery for patients undergoing major surgery. This evidence-based care protocol developed by the ERAS Society is based on research by Michael “Monty” G. Mythen, MBBS, M.D., an anesthesiologist in the United Kingdom.


The ERAS program signifies a paradigm shift in perioperative care. It re-examines outdated practices, replacing them with evidence-based best practices. It also is comprehensive in scope, covering all areas of a patient’s journey through surgery. The ERAS process starts in
pre-admission testing and continues through the perioperative phase and then discharge.


The protocol describes the perioperative care pathway, with recommendations for patient care at various steps in the process. There are about 20 care elements that have been shown to influence care time and postoperative complications. Basic elements of the program include:

• Carbohydrate-loading before surgery

• No prolonged fasting before surgery

• Maintaining normal temperature and blood volume during surgery

• Postoperative pain control via epidurals and TAP blocks

• Early mobility

• Early nutrition by mouth

• Patient education and ownership of the healing process


The central tenets of the ERAS pathway address these key factors, helping to clarify how they interact and affect patient recovery. The ERAS program also guides everyone involved, including the patient, in perioperative care, helping the team provide the best possible care.

Use of the ERAS pathway has been shown to improve patient satisfaction, decrease length of stay (LOS), reduce readmissions and reduce postoperative complications. Early data results from the Norton Audubon ERAS program demonstrate improvement in all of these patient outcome metrics, especially LOS. Preliminary calculations indicate that the ERAS program helped reduce LOS from 10.2 to 4.8 days for 56 colon surgery patients. Norton Audubon is very pleased with the positive results we are realizing so early in the program.



Implementing this program has required a major team effort. Anesthesiologist Patrick T. Shanahan, M.D., Carrie Chesher, APRN, and Desiree Chappel, CRNA, have led the way for this program within Surgical Services. Nurse managers, assistant nurse managers, educators, nurse practitioners and staff nurses have demonstrated strong leadership throughout this successful process. Norton Audubon Hospital is excited to continue this program into 2016 and plans to make ERAS the standard of care for all surgical patients in the near future.




1. Varadhan K, Neal K, Dejong C, Fearon K, Ljungqvist O, Lobo D. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized control trials. Clinical Nutrition. 2010;29(4):434-440.

From left, Desiree Chappell, Carrie Chesher, R.N., and Patrick T. Shanahan, M.D.

"Reaching for Zero" initiative enhances safety

As a part of Norton Healthcare’s Reaching for Zero journey, Norton Healthcare nurses gave their time and expertise to many patient safety-related projects during 2015.


A multidisciplinary team of nurses and staff from Clinical Engineering, Risk Management, Patient Safety and Clinical Effectiveness took on the evaluation of critical clinical alarms, addressing the issues of effective alarm management and alarm fatigue. A primary goal of the team was to identify alarms that are unnecessary “nuisance” alarms and limit alarms to those that are actionable. Alarm parameters for certain types of devices were reconfigured using evidence-based guidelines. Staff was educated about proper lead placement and other interventions to reduce unnecessary alarms. Follow-up measurement will be conducted to evaluate the effectiveness of the team’s actions.


To reduce the occurrence of retained foreign objects following surgical or invasive procedures, a multidisciplinary team conducted a thorough analysis of the processes for instrument and other soft goods counting. After identifying significant variation in process and documentation methods, the team developed a new process that is based on current best-practice and high-reliability principles.


A team representing nurses from all facilities took on the task of examining and standardizing processes for nursing shift handoff. The importance of the handoff being done at the bedside is well supported in nursing literature. Through the team’s hard work, a standard process and Epic template were developed. The new process is being tested at this time.


Together, Nursing is making strides in our journey toward zero harm events.


Deve Vetter, R.N., M.S., CPPS

Patients and families ‘say thanks’ with employee recognition effort


Members of the Norton Healthcare Patient and Family Advisory Council (PFAC) helped create the “Say Thanks” employee recognition program. The council includes patients, family members and health care providers who are committed to ensuring all those served by Norton Healthcare have a voice. As of January 2015, nearly 1,000 employees, 306 of whom are nurses, had received positive feedback from patients and family members through this tool. Each quarter, recognized employees have been invited to attend a celebration in their honor at various locations systemwide. Celebrations include food, door prizes, a photo booth and chances to win great giveaways. Recognized employees and their leaders have attended these events with employees and facility leadership. In addition to knowing they have made a positive impact on our customers, Say Thanks recipients also receive
N Recognition of You points. All visitors to Norton Healthcare can thank staff by clicking the Say Thanks banner on their MyChart homepage, or by accessing the link under the Patients and Visitors tab at Employees who have been recognized this quarter, or any previous quarter, are invited to attend with their leaders.



Christina Vanover, R.N., (left) and Kristen Wieder, R.N., BSN