In a message dated 1/23/03 4:57:01 PM Eastern Standard Time,
[log in to unmask] writes:

> Our hospital has, as a standing order, "lactation consultation prn" - which
> mean the doctor, nurse or patient can request a consult.  The LCs cannot
> just
> initiate their own consult or review the medical records because they hear
> about someone 2nd hand.  If our LCs hear about something, they go to the
> doctor or nurse caring for the patient and ask to be consulted.
>
>

I see several issues and many questions here.
In the hospital I work at, we the LC's, visit every breastfeeding mother and
also work on a consulting basis from the staff.  I have also visited mothers
who marked down their interest in breastfeeding at delivery and then changed
over to formula feeding once they came to postpartum.  Patients that we have
consults on, I read over their charts for more information to help me with
their care.
My first question relates to what I put out to this group a couple weeks ago,
with the HIPAA regulations coming into play will this kind of practice of
seeing patients without consults be prohibited?  As consultants will we have
to have the staff make out consults so we will be able to see patients and
look at their records?
My next question goes out to people such as Anne Merewood and others in Baby
Friendly hospitals.  The maternity staff talks to all mothers about
breastfeeding.  If a mother says she is not breastfeeding based on an
erroneous reason can they tell the mother this or do they have to go to their
clinicians to discuss this?  I am thinking of the case on LACTNET regarding
the Hep B.  If a nurse assigned to care for this mother asked her about
breastfeeding and the patient states she was told she could not, how do you
handle this?
At the minimum I think we have an obligation to inform the clinicians on the
most current research and try to correct misinformation.
I really hope this HIPAA does not tie our hands.
Ann Perry RN IBCLC
Boston, MA

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