2/1/2016 LACTATION CARE MAP Disclosures at CHOC Childrens Crystal - - PDF document

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Cindy Baker-Fox RN, BSN, IBCLC Crystal Deming RN-NIC, BA, IBCLC

LACTATION CARE MAP

at CHOC Children’s Neonatal Intensive Care Unit

• Crystal Deming has nothing to disclose.
• Cindy Baker-Fox is an adjunct instructor for the University
• f California San Diego Extension Lactation Educator

Counselor Program Disclosures Following this session, the learner will be able to:

• Verbalize the importance of an NICU Lactation Care Map

and its impact on improved lactation services and patient satisfaction.

• Identify the role of each key NICU team member in the

lactation care process.

• List 3 key educational components to be presented within

the first 24 hours post NICU admission. Objectives Where we have been….

CHOC 1964 CHOC NICU 1960’s

CHOC 2014

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• Free standing children’s hospital

− 279 total beds − Adjacent to a delivery hospital

• NICU Statistics

− Level IV − 67 total beds (including a 12 bed Small-Baby-Unit) − Average 775 admits/year 2013-2015 (60 SBU admits/year) − 42 Attendings, 8 Fellows, Residents − 174 NICU RN’s

• Outreach

− 9 NICU’s in 4 counties totaling 219 beds − Active outreach program − M&M rounds & bi-weekly CHOC speakers

CHOC Children’s NICU

CHOC SBU 2010

Focus of Lactation Consultant Service

• Infants with the longest hospital stay and most

complicated courses

− SBU, Neuro, Surgical, Cardiac

• Hyperbili admits
• Mothers with highest lactation failure risk

− Long term pumping − Extreme prematurity

• Goal: Increase breastmilk at d/c for infants <1500 g & with

high risk dx

• Goal to improve lactation care and rates through:

− Consistent messaging among all healthcare providers. − Ensuring around the clock availability of information. − Promote early and timely initiation of milk expression. − Properly utilize the limited hours of the lactation consultants.

• Outlined key points of lactation care to be provided by the

bedside RN and the NICU RN IBCLC.

• Created algorithm of basic care and delineation of duties.

− Initial algorithm focused LC time on <1500 g − Phase II expanded to <1800 g to capture other high risk dx

Care Mapping Using the Care Map

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Role of the Admitting Bedside RN

Give a “Breastfeeding for Success Bundle” & review contents

“Breastfeeding for Success Bundle”

Pump kit In basin Cooler Pack with Colostrum collector kit Dot Stickers for 1st & 2nd week’s breastmilk Water Bottle Scent Cloths & lovey doll

Breast Pump for Home The “Your r Milk is Medicine” Pamphlet

Stress Importance of Early Hand Expression and frequent HOP

We recommend Morton Videos & assist as needed

Morton, J, et al. Journal of Perinatology. 2009:29, 757-764

Pumping and Breastfeeding Logs Role of the IBCLC for the Lactation Admit

• 1. Meet or Call Mom

IBCLC Consult

• 2. Review supplies & info

& pump for home

• 3. Develop a Personal Plan

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Our IBCLC Team ONGOING Lactation Support

1st PO feed at Breast Daily Skin to Skin Care Pumping & Lactation Support Daily Breastfeeding as po feedings increase

EVERYONE is part of our team!

Milk Lab IBCLC assisting BF Parents RN giving BF Bundle Medical Team Rounding Volunteers pack BF Bundles

• Staffing Adjustments (Nov 2012)

− Staffing shifted to provide 2 lactation FTEs for the NICU.

• ELBW Lactation Intervention Study (May 2013)
• Loaner Pump Program Enhancements (July 2013)
• Education to physicians & staff
• Lactation Rounds
• Antenatal consult scripting
• Participation in VON collaborate

Concurrent Initiatives

• Twice yearly CLEC courses on CHOC campus
• Promotion of IBCLC course to NICU staff
• Rotating scholarship CLEC or IBCLC courses
• Resource Team development and training
• BF and BM goals part of all staff annual evaluation

Results of the Initiatives % of VLBW Infants with MBM Available at Hospital D/C

66.7 62.3 58.7 61.5 82 81 80 10 20 30 40 50 60 70 80 90 2009 2010 2011 2012 2013 2014 2015

Bixby C, Steele C, et al. BF Med. 2014;9 (supp 1):S-12 Bixby C, Steele C, et al BF Med. 2016 in press

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Results Presented at ABM 2014

Full article accepted for publication in Breastfeeding Medicine January 7, 2016

National Recognition

What’s Next at CHOC?

CHOC Logs & Equipment

Lactation Info changed to purse size & log added within Increasing # & standardizing type

• f Pumps available

for hospital use Increasing # of breastfeeding scales & pillows

. The SummaryM of Lactation Details

..now

• Total inventory &

by day

• Diet Order
• Graph of milk type

& route

• IBCLC Charting

..next

• Improved charting
• Interface other staff

charting

• Add BF

Assessment from all staff

Lactation Resource Team

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Tool for Breastfeeding Assessment

• Define breastfeeding behaviors
• Increases lactation knowledge
• f staff
• Lists milk supply expectations &

interventions

• Defines intervention needed

and when to promote independence

• Consistency among team

members

Breastfeeding Care Pathway: Term Infant The Goal.. BREASTMILK & BREASTFEEDING!!