I'm not sure how many on this list work in a NICU setting, but I'm hoping for some feedback here. I've been an LC in a hospital setting for nearly 15 years. I feel extremely accomplished and well respected on the OB Unit here. I am able to follow complicated cases until discharge and then develop feeding plans which are extremly helpful to staff and physicians. In fact, many physicians won't let the couplet go home until they have seen me. On the other hand, I have never felt completely at ease in the NICU. The babies there are very complicated, the staff is always changing, and the babies are there for a long time. It is so difficult, because I can suggest something one day, and in 3-4 days it is completely overriden. Babies are overfed from the start (I'm mainly talking about those full termers admitted for infection, hypoglycemia, etc), and while test weights for preemies was just initiated a couple of months ago, staff are still reluctant to use this sytem, and prefer to make supplementation decisions based on minutes nursed. Very, very frustrating part of my job. 

So yesterday, a patient finally gave some feedback on the all-important patient followup phone call after discharge which rated the care as "very good" instead of "excellent". ptient stated, "There was inconsistency on the feeding plan between the speech specialist, the NNP, the nurses and the Lactation staff.  That could have been better.”

This negatively effects the PRC score of the unit, and therefor we have all be summoned to attend a meeting next week to discuss how this situation of conflicting advice can be resolved. Honestly, this has been an issue forever, it's just this one patient who has ever said anything about it. I am lost as to a solution, because of the complexities of the situation - rotating staff, NNPs, physicians and LCs - make this a tough problem in my eyes. I'm looking to see if anyone on the LACTNET list can chime in with improvement process that worked at their facilities. 

Thank you!!

Brenda Phipps, BS, IBCLC

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