Becky has asked about the need for her to utilize lactation protocols in  her 
institution. Do you know why you were asked for these? It could be that  
there are a number of reasons for such a request: Joint Commission wishes  to see 
these, hospital liability issues whereby care must follow established  
guidelines, patient complaints of inconsistent information, etc. What you might  find 
helpful instead of rigid protocols is the use of clinical algorithms, flow  
charts, or decision trees. These allow for the many variables that are part of  
managing breastfeeding situations and problems. These allow the clinician to 
ask  a question and follow a path depending on the answer. While our work is 
fluid  with many variables, if you have to put it onto paper, this may be a 
reasonable  accommodation. There are many of these in use, some of which have 
also been  published. Many of us use them as models to create our own.
 
Marsha Walker, RN, IBCLC
Weston, MA

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