> I have recently had to
> admit two neonates that were in big time trouble but instead of calling
> me, they were calling, talking and receiving advice from their lactation
> specialist. Even when I would call them, they would "think" that
> everything was "okay" because they had already talked with their
> lactation specialist.
>
There was a real problem here if babies had to be readmitted.
The bigger problem as I see it, was the lack of communication between
the LC and the MD. The LC in this situation needs some education, albeit
they got one (hopefully) when the babies were readmitted. Was it really
an LC, I wonder, or did mom just refer to her that way?
No longer can health care be practiced "solo". We are in a team
environment, like it or not, for better or for worse. The doctor posting
to NICU-net was Right On, IMHO. Dani is also Right On about this need
for teamwork and education.
Even though, as an RN, I have a license under which I can be held liable
*all by myself* (and for which I pay malpractice insurance), somehow, I
have *never* considered myself to be solely responsible (in a
medico-legal sense) for any mother-baby couple with whom I consult.
Ultimately, the pediatrician is liable for the health and well-being of
the baby.
This is how I try to avert the problem referred to on NICU-net. For
nearly every consult I do, I make a courtesy call to the peds office,
usually speaking to the back-office nurse leaving a message for the doc
along the following lines: "Please tell Dr. So-and-So that I saw baby
Smith today, age 5 days, for breastfeeding difficulties. Baby weighed
7#3 today, down 6 ounces from birthweight. Baby has adequate output and
is slightly jaundiced. We worked on latch-on and scheduling. Mom is
supplementing at night. I will be visiting again tomorrow and getting
another weight then. I will keep you posted. Is there anything else Dr.
would like me to do?" The next day, the message is shorter: "Baby
weighs 7#4, up 1 ounce and is nursing for longer periods now, peeing and
pooping well. I will continue daily contact with mom for now. She'll be
coming for her first visit in 3 days." or whatever.
I *always* weigh babies on home visits, BTW. I do *not* let moms weigh
babies though, as that is a "crazy-maker" for her, but weights are the
bottom line when you come right down to it, and weights are quantifiable
benchmarks that are easily communicated to a HCP.
This phone call does several things. First, it alerts the MD that there
is a problem.
Second, Someone is evaluating the problem and working on it.
Third, this Someone is communicating and can probably be counted on to
alert to a Real Problem.
Fourth, it gives the MD an opportunity to exert some control, if needed.
Some peds prefer that the moms come into their office anyway for weight
checks. That's fine with me. Sometimes, the ped knows something I don't
about the family, and communicates this to me, changing my whole
approach sooner, rather than later. I am not offended.
Fifth, it establishes my practice as a professional, collaborative
practice.
Eventually, some peds have told me, "It sounds like things are going
better - you needn't call in any more weights. Just let me know if there
is a major change."
And when I complete the consulting relationship, I send a brief letter
summarizing what took place, always thanking the doctor for "allowing me
the privelege of working with you for this very interesting patient."
This is no less than MDs do for each other.
Katharine West, BSN, MPH
Sherman Oaks, CA
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