Safe and Healthy Beginnings: A Resource Toolkit for Hospitals and Physicians' Offices

If you are interested in purchasing Safe and Healthy Beginnings: A Resource Toolkit for Hospitals and Physicians’ Offices, please visit the AAP Bookstore.

To see a demo of the toolkit, visit http://www.aap.org/pubserv/shb/index.html, click on the play button once the video appears to view presentation.

Safe & Healthy Beginnings: A Resource Toolkit for Hospitals and Physicians’ Offices was developed as part of the American Academy of Pediatrics (AAP) Safe and Healthy Beginnings program. Safe and Healthy Beginnings is a pilot project of the AAP Quality Improvement Innovation Network through a partnership with the Center for Health Care Quality at Cincinnati Children’s Hospital Medical Center. The project was designed to ensure a safe and healthy beginning for all newborns by testing measures, strategies, and tools based on the key aspects of the revised AAP hyperbilirubinemia guideline, including 1) the assessment of a newborn’s risk for severe hyperbilirubinemia, 2) support for breastfeeding mothers, and 3) coordination of care between the newborn nursery and primary care practice—the newborn’s medical home. As a result of this project, these tested tools are now available for widespread use. Safe and Healthy Beginnings was funded by the AAP, the AAP Section on Perinatal Pediatrics, McNeil Consumer Healthcare, and the Centers for Education & Research on Therapeutics of the Agency for Healthcare Research and Quality.

Assessing Your Systems for Newborn Care

Tools for Newborn Nursery Clinicians

• Safe and Healthy Beginnings Newborn Nursery Inventory

  This tool can be used to assess the current systems that support comprehensive newborn care and may highlight areas where improvement could benefit your patients.

• Safe and Healthy Beginnings Newborn Discharge: A Readiness Checklist

  This checklist can be used to evaluate your current newborn nursery discharge processes. It can also be adapted for predischarge use or used as a teaching tool for students and residents.

• Bright Futures Newborn Hospital Documentation Form

  Thorough documentation of medical visits is critical to ensuring quality care, proper billing, and reduced liability exposure. The American Academy of Pediatrics (AAP) Bright Futures initiative has developed a newborn documentation form to be filled out at the hospital based on the information in the AAP Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, to make it easy to keep accurate and complete records of this very first well-child visit and provide documentation support for coding.

Tools for Primary Care Clinicians

• Safe and Healthy Beginnings Primary Care Practice Inventory

  This tool can be used to assess the current systems that support comprehensive newborn care and may highlight areas where improvement could benefit your patients.

• Safe and Healthy Beginnings First Newborn Visit Checklist

  This checklist includes areas to be addressed at the first newborn visit following discharge.

• Well Child/2 to 5 Days (First Week) Pediatric Visit Documentation Form

  This 1-page form for the 2- to 5-day (first week) visit uses check boxes to speed documentation (with space for notes, if needed) and provide documentation support for coding. For efficiency and accuracy, this updated form is now consistent with the new AAP Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition. A printed copy is provided with this toolkit.

• Bright Futures Previsit Questionnaire: 2 to 5 Day (First Week) Visit

  This very important questionnaire based on the AAP Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, is to be filled out by the parent/guardian and covers essential medical screening questions, as well as parental concerns and questions about their baby and home environment.

• Safe and Healthy Beginnings Newborn Primary Care Visit: The Pediatric Practitioner’s Guide to Coding and Getting Paid

  This pamphlet is a guide to help pediatric practitioners get paid appropriately for the care provided to newborns, with particular attention to payment for jaundice evaluation and breastfeeding support.

Parent Handouts

• Bright Futures Parent Handout: Newborn Visit

  Based on the 5 priorities outlined in the Newborn Visit in the AAP Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, this 1-page handout is designed to help families by providing information on topics such as family readiness, feeding, safety, and routine baby care. This age-appropriate form also offers families information about what to expect at the next well-child visit, the 2 to 5 Day (First Week) Visit, to help families prepare a list of questions and concerns for their health care provider.

• Bright Futures Parent Handout: 2 to 5 Day (First Week) Visit

  Based on the 5 priorities outlined in the First Week Visit in the AAP Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, this 1-page handout is designed to help families by providing information on topics such as maternal wellness, feeding, new baby care, and newborn safety. This age-appropriate form also offers families information about what to expect at the next well-child visit, the 1 Month Visit, to help families prepare a list of questions and concerns for their health care provider.

• Caring for Your Baby (English and Spanish versions included)

  This tool is designed to summarize the most critical information parents need in the first few days following their baby’s discharge from the newborn nursery. This can be adapted to meet your nursery’s specific guidelines and resources.

Assessment of Risk for Severe Hyperbilirubinemia

Tools for Clinicians

• Is the Baby at Risk for Severe Hyperbilirubinemia? Predischarge Assessment of the Risk for Severe Hyperbilirubinemia in Newborns 35 or More Weeks of Gestation

  This tool may be used to assess the risk for severe hyperbilirubinemia in the newborn and to provide guidelines for further testing, the use of phototherapy, and follow-up care. It may be used as a worksheet for each baby in the newborn nursery with transfer of key information to the primary care site for review at the first newborn visit.

• Assessment of Risk for Severe Hyperbilirubinemia Pocket Card

  This pocket card can be laminated and carried by clinicians for quick reference. A laminated card is provided with this toolkit. The risk factors for severe hyperbilirubinemia are on one side and the risk zones for serum bilirubin levels are on the other.

• Phototherapy Guidelines Pocket Card

  This pocket card can be laminated and carried by clinicians for quick reference. A laminated card is provided with this toolkit. This tool is a graphic guideline for phototherapy based on the serum bilirubin level and hours of age.

• Letter to Primary Care Physician From Hospital About Newborn Follow-up

  This sample letter informs primary care practices that most newborns discharged within 72 hours after birth will be scheduled for their first appointment within 2 days. This can be adapted to meet your nursery’s specific guidelines.

• Sample Hospital Policy: Management of Hyperbilirubinemia in the Normal Newborn Nursery

  This sample hospital policy, based on AAP guidelines, includes medical and nursing policies for the assessment of the newborn’s risk for severe hyperbilirubinemia and for appropriate medical and nursing management.

Parent Handouts

• Questions and Answers: Jaundice and Your Newborn (English, Spanish, Chinese, and Italian versions included)

  This tool is a simple set of frequently asked questions that can be provided to parents before discharge. A printed copy (English) is provided with this toolkit.

Breastfeeding Support

Tools for Clinicians

• Clinical Care Path for Breastfeeding

  This is a 4-part tool designed to help clinicians promote breastfeeding in the prenatal and postpartum period, identify concerns that require follow-up, and assess the need for additional care, counseling, and referral. The tool includes specific questions clinicians can ask, a list of red flags they should monitor, and suggested resources and types of support.

• Sample Hospital Breastfeeding Policy for Newborns

  This sample, based on AAP guidelines, may be used to model or adapt a hospital policy addressing support of breastfeeding. Use the references to develop or refine your own policy or for professional education.

• Infant Breastfeeding Assessment Tool (IBFAT)

  The IB FAT is a structured assessment of breastfeeding. Systematic use can help identify which mothers and babies need additional support or referral. This tool incorporates the mother’s assessment of breastfeeding. (Note: the readiness-to-feed criterion is not relevant if the mother and baby are rooming in and feeding on demand.)

• LATCH: A Breastfeeding Charting System and Documentation Tool

  LATCH is a structured assessment of breastfeeding. Systematic use can help identify which mothers and babies need additional support or referral.

• Mother-Baby Assessment Tool

  The Mother-Baby Assessment Tool is a structured assessment of breastfeeding. Systematic use can help identify which mothers and babies need additional support or referral. This tool incorporates information from the mother into assessment and scoring.

• A Clinician’s Guide: Suggested Questions to Assess Breastfeeding in Primary Care Practice

  This tool was developed by breastfeeding experts to assess the need for additional care, counseling, and referral of the newborn and mother seen in primary care practice.

• Breastfeeding Assessment Checklist for Mothers in Primary Care Practice (English and Spanish versions included)

  This tool was developed as a companion to A Clinician’s Guide: Suggested Questions to Assess Breastfeeding in Primary Care Practice. This checklist provides a structured assessment of breastfeeding that can be given directly to the mother to complete and can be used to complement questions and direct observation by the clinician.

• Assessing Your Local Breastfeeding Resources (English and Spanish versions included)

  This tool may be used to inventory links that your practice has to local breastfeeding resources or to develop specific patient handouts in your geographic area.

Parent Handouts

• Breastfeeding Record for Baby’s First Week (English and Spanish versions included)

  This user-friendly record provides a place for mother to track the first week of breastfeeding and instructions to share any difficulties or questions with a health care professional or lactation expert.

• Breastfeeding Your Baby: Answers to Common Questions (English and abbreviated Spanish versions included)

  This comprehensive pamphlet published by the AAP offers guidance for multiple aspects of breastfeeding. A printed copy (English) is provided with this toolkit. This tool is suitable for mothers considering breastfeeding and for those who are already breastfeeding.

Suggested Resources (English and Spanish versions included)

This list provides Web site links for downloadable resources on hyperbilirubinemia and breastfeeding.

If you are interested in purchasing Safe and Healthy Beginnings: A Resource Toolkit for Hospitals and Physicians’ Offices, please visit the AAP Bookstore.

Additional information about Safe and Healthy Beginnings can be found at http://www.aap.org/qualityimprovement/quiin/SHB.html

The SHB Toolkit is endorsed by the Child Health Corporation of America and The Joint Commission.