In our Level II hospital, the problem was "solved" by putting the cost of
pump kits, breast shells, Lansinoh, etc. into the room charge, so that
theoretically all mothers are charged for these items whether they actually
use them or not.  This practice was in place when I came here and it is an
issue I want to look at (when I have time!).  Problems I have seen with
this system include the handing out of equipment by the staff without the
proper assessment of need.  I have received some complaints from mothers
who are upset that they are being given all this "stuff" that they feel
they don't need and for the ones whose confidence in their ability to
breastfeed is faltering anyhow, it can overwhelm them and breastfeeding
goes out the window.
Our nipple shields, tho, are dispensed thru out Pyxsis unit.  I am
responsible for keeping the drawer stocked (not pharmacy) and get a
printout once a month showing who has signed out a shield for which
mother.  This system holds the nurse accountable for her actions - some of
the staff don't like it, but I feel I am seeing some of the staff having
second thoughts about giving out the shield. This system also allows the
staff to get credit for their assessment skills, unlike shields being
locked up in the office and dispensed at the LC's discretion.  They also
have to give the reason why it is being given.  I'm seeing some interesting
trends and am also seeing where some inservicing needs to be done.  For
example, the definition of "flat nipple".  I'd be interested in hearing
from anyone else who is using a similar system.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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