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 o 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 o 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 • PCs completed on the same – Information and dates day nutrition education on the Breastfeeding was completed Peer Counselor page in HANDS must match • TGIF documentation shall Notes tab in HANDS 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.
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?
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