TGIF Notes Skill Building May 9, 2018 A Partnership for - - PowerPoint PPT Presentation

TGIF Notes – Skill Building

May 9, 2018 A Partnership for Breastfeeding Success Halle Heart Museum Amanda Shumway | IBCLC

Recap T: Tool G: Goal I: Information F: Follow Up

T: Tool

• Getting to the Heart of the Matter Tool used,

if applicable

• Example:

T: magic wand. Mom wishes she had enough milk to exclusively breastfeed baby.

G: Goals

• Personal goals or areas identified by

participant that they plan to work on

• Example:

Mom plans to latch infant more often to her breast, aiming for at least 8xday. She will try to latch baby at signs of early hunger cues instead of waiting until her baby is crying.

I: Information

• Knowledge, feelings and beliefs of breastfeeding for pregnant and

breastfeeding women categories

• Caregiver knowledge, feelings, motivations, and challenges and

nutrition education topics discussed

• Caregiver knowledge, feelings, beliefs of infant feeding for infant

category

• Any information that is pertinent to the interaction during the visit
• Notes reflecting any new risk factors that were identified at

nutrition education visit

• Reasons for food package assignment: o For any participant with

tailored food package o For any participant getting Food Package III

• For any infant receiving formula, show how the amount of

formula on food package was determined

• Further detail on nutrition education provided as needed to clarify

I: Information (PCs)

• Knowledge, feelings and beliefs of breastfeeding for pregnant and

breastfeeding women categories

• Caregiver knowledge, feelings, motivations, and challenges and

nutrition education topics discussed

• Caregiver knowledge, feelings, beliefs of infant feeding for infant

category

• Any information that is pertinent to the interaction during the visit
• Notes reflecting any new risk factors that were identified at

nutrition education visit

• Reasons for food package assignment: o For any participant with

tailored food package o For any participant getting Food Package III

• For any infant receiving formula, show how the amount of

formula on food package was determined

• Further detail on nutrition education provided as needed to clarify

F: Follow-up

• Any information that the staff person has

identified as areas to follow-up with at subsequent visits.

• Note: The TGIF documentation shall be

tailored per individual. Documenting the identical note in each individual care plan in a family is not acceptable.

Why are notes important?

• USDA requirement
• Continuum of care
• Completes documentation of nutrition

assessment

• If there is no note at certification, the

certification is no longer active (not for PCs)

• Protect yourself

Remember

• TGIF notes must be

completed on the same day nutrition education was completed

• TGIF documentation shall

be tailored per individual. Documenting the identical note in each individual care plan in a family is not acceptable.

• If it is not documented, it

didn’t happen.

• PCs

– Information and dates

• n the Breastfeeding

Peer Counselor page in HANDS must match Notes tab in HANDS

Examples

What would you change?

• T: magic wand
• G: continue BF
• I:

– Mom is nursing baby daily. States she feels like she doesn’t have enough milk at times, but doesn’t want to offer formula. – Mom reports doctor was concerned with infants weight at last visit, but she is not worried. – Mom doesn’t know how many times per day she BFs, but sometimes gives the pacifier so she can finish errands. – No referrals made at this time, mom is happy with BF

• F: PC will F/U in one month to see if anything has

changed

• T: magic wand – mom is happy with breastfeeding so far
• G: continue BF BF on demand, aim for 8-12 feedings in 24 hours.
• I:

– Mom is nursing baby daily. States she feels like she doesn’t have enough milk at times, but doesn’t want to offer formula. Probed about “not enough milk”. Educated on supply and demand, enough wet/dirty diapers. – Mom reports doctor was concerned with infants weight at last visit, but she is not worried. Encouraged mom to follow up with pediatrician, offered to weight infant today. – Mom doesn’t know how many times per day she BFs, but sometimes gives the pacifier so she can finish errands. Discussed BF 8-12xday, encouraged mom to keep track for a few days. Refreshed on hunger and fullness cues. Gave examples to mom. – No referrals made at this time, mom is happy with BF Referred mom to IBCLC and Pediatrician. Offered BF Hotline#

• F: IBCLC/RD will F/U in one month ASAP

• T: none, phone conversation
• G: continue BF on demand, watch for growth

spurts I:

– Mom reports BF is going well. Mom is happy she is able to EN. Infant is almost 6 weeks old. Affirmations to mom. – Reminded mom about 6 week growth spurt and what to watch for. Discussed cluster feeding. – Encouraged mom to continue taking prenatal vitamins and to remember to schedule postpartum visit

• F: How is BF? Did mom notice growth spurt?

Postpartum visit?

• T: none, phone conversation
• G: continue BF on demand, watch for growth

spurts I:

– Mom reports BF is going well. Mom is happy she is able to EN. Infant is almost 6 weeks old. Affirmations to mom. – Reminded mom about 6 week growth spurt and what to watch for. Discussed cluster feeding. – Encouraged mom to continue taking prenatal vitamins and to remember to schedule postpartum visit

• F: How is BF? Did mom notice growth spurt?

Postpartum visit?

• T: none, phone conversation
• G: continue taking prenatal vitamins
• I:

– Client shared that BF was hard in the beginning, but getting better now. She is glad to have support from WIC. – Client shared that she is constantly arguing with husband about financial issues, explained she wants a new “mom car” – Client mentioned that she is sleeping for longer periods of time now that infant is getting a little older. – Encouraged mom to keep up the good work. Offered hotline # if mom needs help at night or on the weekend. – Mom shared she plans to BF until infant is at least 1 year old, affirmations to her – Client asked if she should still be taking prenatal vitamins, encouraged her to continue and to follow up with doctor

• F: Any new changes with BF? Prenatal vitamin?

• T: none, phone conversation
• G: continue taking prenatal vitamins
• I:

– Client shared that BF was hard in the beginning, but getting better now. She is glad to have support from WIC. – Client shared that she is constantly arguing with husband about financial issues, explained she wants a new “mom car” – Client mentioned that she is sleeping for longer periods of time now that infant is getting a little older. – Encouraged mom to keep up the good work. Offered hotline # if mom needs help at night or on the weekend. – Mom shared she plans to BF until infant is at least 1 year old, affirmations to her – Client asked if she should still be taking prenatal vitamins, encouraged her to continue and to follow up with doctor

• F: Any new changes with BF? Prenatal vitamin?

• T: none, text follow up
• G: contact doctor ASAP
• I:

– Mom shares BF is not going as well as it was last

• week. Mom stated her breast is red and she feels

like she might be getting the flu, encouraged mom to reach out to doctor ASAP. – Referred mom to IBCLC/RD. IBCLC will call today.

• F: Did mom follow up with doctor? IBCLC?

• T: none, text follow up
• G: contact doctor ASAP
• I:

– Mom shares BF is not going as well as it was last

• week. Mom stated her breast is red and she feels

like she might be getting the flu, encouraged mom to reach out to doctor ASAP. – Referred mom to IBCLC/RD. IBCLC will call today.

• F: Did mom follow up with doctor? IBCLC?

• T: none, phone conversation
• G: continue BF on demand, watch for growth

spurts I:

– Mom reports BF is going well. Mom is happy she is able to EN. Infant is almost 6 weeks old. Affirmations to mom. – Reminded mom about 6 week growth spurt and what to watch for. Discussed cluster feeding. – Encouraged mom to continue taking prenatal vitamins and to remember to schedule postpartum visit

• F: How is BF? Did mom notice growth spurt?

Postpartum visit?

• T: none, phone conversation
• G: continue BF on demand, watch for growth

spurts I:

– Mom reports BF is going well. Mom is happy she is able to EN. Infant is almost 6 weeks old. Affirmations to mom. – Reminded mom about 6 week growth spurt and what to watch for. Discussed cluster feeding. – Encouraged mom to continue taking prenatal vitamins and to remember to schedule postpartum visit

• F: How is BF? Did mom notice growth spurt?

Postpartum visit?

• T: faces – confused, mom feels confused and worried about constant

“marbles” in her breasts

• G: try to fully drain breasts after every feed, apply warm/cold compresses

as needed, use gentle breast massage

• I:

– Mom shared that she always has hard painful “marbles” in her breasts. She reports that sometimes they go away, but not always. Stated she needs relief now or she may need to stop BF completely. – Educated mom on treatment of recurrent plugged ducts. Encouraged her to use warm compresses for short periods of time, and cool compresses to help reduce swelling. – Explained importance of fully draining breasts after every feed, suggested pumping or manual expression after feeding if mom doesn’t feel her breasts soften. – Encouraged gentle breast massage while infant is eating and in the shower to help release plugged ducts. Mentioned to mom that facing the infants chin towards the duct can help alleviate the area. – Gave BF hotline, instructed her to call doctor if flu like symptoms develop

• F: how are mom’s breasts feeling? Have the recurrent plugged ducts been

resolved? How is BF going?

• T: faces – confused, mom feels confused and worried about constant

“marbles” in her breasts

• G: try to fully drain breasts after every feed, apply warm/cold compresses

as needed, use gentle breast massage

• I:

– Mom shared that she always has hard painful “marbles” in her breasts. She reports that sometimes they go away, but not always. Stated she needs relief now or she may need to stop BF completely. – Educated mom on treatment of recurrent plugged ducts. Encouraged her to use warm compresses for short periods of time, and cool compresses to help reduce swelling. – Explained importance of fully draining breasts after every feed, suggested pumping or manual expression after feeding if mom doesn’t feel her breasts soften. – Encouraged gentle breast massage while infant is eating and in the shower to help release plugged ducts. Mentioned to mom that facing the infants chin towards the duct can help alleviate the area. – Gave BF hotline, instructed her to call doctor if flu like symptoms develop

• F: how are mom’s breasts feeling? Have the recurrent plugged ducts been

resolved? How is BF going?

Time to yield for PCs. Client needs to be referred to DBA, RD,

• r IBCLC ASAP. This

note is not appropriate for PC. Out of PCs scope.

• T: faces – confused, mom feels confused and worried about constant

“marbles” in her breasts

• G: try to fully drain breasts after every feed, apply warm/cold compresses

as needed, use gentle breast massage

• I:

– Mom shared that she always has hard painful “marbles” in her breasts. She reports that sometimes they go away, but not always. Stated she needs relief now or she may need to stop BF completely. – Educated mom on treatment of recurrent plugged ducts. Encouraged her to use warm compresses for short periods of time, and cool compresses to help reduce swelling. – Explained importance of fully draining breasts after every feed, suggested pumping or manual expression after feeding if mom doesn’t feel her breasts soften. – Encouraged gentle breast massage while infant is eating and in the shower to help release plugged ducts. Mentioned to mom that facing the infants chin towards the duct can help alleviate the area. – Gave BF hotline, instructed her to call doctor if flu like symptoms develop

• F: how are mom’s breasts feeling? Have the recurrent plugged ducts been

resolved? How is BF going?

Good note for DBA. Should have been flagged as 602 and referred to RD

• r IBCLC for follow up.

THANK YOU

Amanda Shumway | IBCLC Amanda.shumway@azdhs.gov | 602-376-6951 azhealth.gov @azdhs facebook.com/azdhs