Hi Germaine,

First, I will say that arbitrarily having an RN round every hour on every
patient is counterproductive, to me. The RN should assess and prioritize. If
I am a well mother with a well baby, or even a not-seriously-ill patient
that does not want/need to be bothered every hour, I would resent those
frequent interruptions. I understand the point of doing hourly rounds, but
that's overkill, IMO.  (I am not talking about pts who need their vital
signs or levels of consciousness or such assessed every hour).

As for the LC, it is inevitable that the LC will miss some feeds, especially
on a busy unit. If babies are brought out from the nursery at 9 am like at
my hospital (nurses do vital signs, assess, and the docs examine between
about 6-9 am --- GRRRR!) then the babies tend to be very hungry all at the
same time and this is ridiculous, to put it mildly. So babies should be
rooming-in and feeding ad lib, and this makes it easier to observe/assist
with feedings, if necessary. I have a postcard with info about our BF
Center, our free services, our names and credentials, and phone no. I give
the card, and tell the mom to call my extension, or if I don't answer, to
ring the nurse call light and they will find me. Sometimes I'm busy with
another mom and can't make it, or sometimes mom forgets. But the ones who
need and also want help will call you. During your workday, there should be
several feeds going on with each baby, so you will be able to catch some of
the feeds. I round about 3x between 8a-4p most of the time.
I will also say, that if a mother indicates the baby is bf well (I ask a few
questions to verify), and she's having no pain, and she and baby seem happy
with bf, then I do not feel I need to visually assess the feed. The mother
is informed, of course, of usual bf patterns, and diaper outputs, etc. We
also have a followup clinic when baby is 4-5 days old, so I make sure to
inform them of that, and that we will be making the appt on day of
discharge.
To enhance pt satisfaction, make use of the time you are in there. Ask if
mom needs anything bf-related or otherwise, extra linen, pillows, or
something to drink. Is the room comfortable, etc. I take care of that stuff
if they request.
Laurie Wheeler MN RN IBCLC
Mississippi USA

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