2/1/2016 LACTATION CARE MAP Disclosures at CHOC Children’s • Crystal Deming has nothing to disclose. Neonatal Intensive Care Unit • Cindy Baker-Fox is an adjunct instructor for the University of California San Diego Extension Lactation Educator Counselor Program Cindy Baker-Fox RN, BSN, IBCLC Crystal Deming RN-NIC, BA, IBCLC Objectives Where we have been…. 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. CHOC 1964 CHOC NICU 1960’s CHOC 2014 1
2/1/2016 CHOC Children’s NICU • 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 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 Care Mapping Using the Care Map • 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 2
2/1/2016 “Breastfeeding for Success Bundle” Role of the Admitting Bedside RN Cooler Pack with Pump kit Colostrum collector Give a “Breastfeeding for Success Bundle” & review contents Water Bottle In basin kit Dot Stickers for Scent Cloths & lovey doll 1 st & 2 nd week’s breastmilk 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 3
2/1/2016 Our IBCLC Team ONGOING Lactation Support Daily Skin to Skin Care 1 st PO feed at Breast Pumping & Lactation Support Daily Breastfeeding as po feedings increase Concurrent Initiatives EVERYONE is part of our team! Volunteers pack Parents • Staffing Adjustments (Nov 2012) BF Bundles IBCLC assisting BF − 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 Medical Team Rounding RN giving BF Bundle Milk Lab • Lactation Rounds • Antenatal consult scripting • Participation in VON collaborate Results of the Initiatives % of VLBW Infants with MBM Available at Hospital D/C • Twice yearly CLEC courses on CHOC campus 90 82 81 80 80 • Promotion of IBCLC course to NICU staff 66.7 70 62.3 61.5 58.7 60 • Rotating scholarship CLEC or IBCLC courses 50 40 • Resource Team development and training 30 20 10 • BF and BM goals part of all staff annual evaluation 0 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 4
2/1/2016 Results Presented at ABM 2014 National Recognition Full article accepted for publication in Breastfeeding Medicine January 7, 2016 CHOC Logs & Equipment Increasing # of breastfeeding scales & Lactation Info What’s Next at CHOC? pillows changed to purse size & log added within Increasing # & standardizing type of Pumps available for hospital use The SummaryM of Lactation Details Lactation Resource Team . ..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 5
2/1/2016 Tool for Breastfeeding Assessment Breastfeeding Care Pathway: Term Infant • Define breastfeeding behaviors • Increases lactation knowledge of staff • Lists milk supply expectations & interventions • Defines intervention needed and when to promote independence • Consistency among team members The Goal.. BREASTMILK & BREASTFEEDING!! 6
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