Dear Christine,
You wrote<<The dietitian at our hospital informed me that JCAHO has been looking at documentation about nutrition education as it relates to lactation. Has
this been your experience? How are you documenting nutrition education in
your institutions?>>

I have just finished working on a grant-funded project called "IBEED" (Integrating Breastfeeding Education to Eliminate Disparities) with Dr. Lori Winter, the Chapter Breastfeeding Coordinator for New Jersey AAP. We were teaching multidisciplinary teams of professionals (docs, nurses, residents, and dietitians) in eight hospitals in NY and NJ (plus two in Puerto Rico that Lori did on her own). We specifically targeted dietitians for several reasons.
1)Some of our area hospitals provide a postpartum visit from a dietitian for ALL breastfeeding mothers.
2) The Masters in Clinical Nutrition program at the University of Medicine and Dentistry of New Jersey (UMDNJ) offers a graduate-level course in breastfeeding, which we have taught three times in the last 5-6 years, so at least in this part of the country, dietitians are being exposed to the idea that they have a role in lactation support.
3) In some of our hospitals, the dietitians were among the most enthusiastic participants in the IBEED program.

Documentation was a major topic for IBEED. One outcome measure we are looking for now is an improvement of documentation of breastfeeding teaching, and ESPECIALLY of breastfeeding assessment, in the mother's and/or baby's charts. In our experience, documentation was NOT GOOD before the program began. (To be fair, I have to point out that we did target hospitals with low bf rates.)

However you decide to tackle the problem of documentation, I think it is an area where you are very likely to win administrative attention and support. Those charts are one way we can prove that we are doing our jobs, and administrators know this! Collaboration between nurses and dietitians is another idea that would probably get you administrative support--don't the "suits" just love multi-disciplinary projects! And, joking aside, mother-baby care is a prime example of an area that needs a multidisciplinary approach.

A case in point about documentation, which Lori Winter often uses as an illustration, is the incidence of dehydration and kernicterus in "breastfed" babies. If no one observes, assesses, and documents how WELL the mom and baby are breastfeeding, then breastfeeding can get the reputation of being a risk factor for hyperbilirubinemia problems. But who is to say whether the "breastfed" babies who ran into trouble were really BREASTFEEDING at all? Or were they just hanging out at the breast? If good latching and suckling and milk transfer were not documented, we don't know if they ever happened. Dietitians could learn to evaluate these things, so if they are talking to a mother while she is feeding, they can say what they observed.

Chris Mulford, RN, IBCLC
working for WIC in New Jersey
Co-coordinator, WABA Women & Work Task Force

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