Karen is right; sometimes babies are discharged who shouldn't be and even
though they are being "treated" for something, they are not really being
followed appropriately or fully.  The National Association of Neonatal
Nurses (NANN) has a practice guideline for "Early Discharge of the Term
Newborn". Their web site is listed as www.nann.org. The practice guideline
is several pages long, very specific and lists criteria for early discharge
and the interventions recommended under each category (ie, Physiologic and
Behavioral Interventions and Rationale, Nutritional Interventions and
Rationale, Safety Interventions). It lists expected outcomes at discharge
and follow-up visits and has references.

This might be a good way for your supervisors to start looking at standards
for discharge within your own institution. (With your great input, of
course!) When we instituted our early discharge program, this was one of our
tools. Infants discharged at less than 48 hours of age return to see the
early discharge nurse (that's me!) by day 5 of age for a weight check,
feeding evaluation (that's where the breastfeeding comes in), valid
metabolic screen and general assessment. JCAHO (Joint Commission on
Accreditation of Hospitals) is very interested in whether infants are being
assessed for jaundice, for example, and if so, how and when is it being
done. In this case, it can easily be documented on the return visit. I
confer with the neonatologist for any problems assessed, since none of these
infants has seen their pediatrician yet except for those who had brief
hospital visits after delivery. The neonatologist then discusses pertinent
information with the pediatrician and they make decisions as needed.

Sometimes things can still fall through the cracks, but not as many or as
often. At least we are starting with babies who fit the criteria for early
discharge. And if we send one home who may be just outside the guidelines,
(ie, perhaps a baby under 37 weeks gestation) we have this program in place
so we can bring them back (at no cost to the parents) to assess them for
progress in those critical areas mentioned in the NANN guidelines.

One of the things that got me my LC/Early Discharge position was the concept
that the hospital could save money by getting delivered patients discharged
sooner so they could admit more in labor in the same time frame. Sounds
mercenary, I know, but for most health care institutions, money is the
bottom line these days. We're trying to make it a safe bottom line for those
babies.

Jean

Jean Macomber, RN, IBCLC
Lactation Consultant
The Family Birth Place
St. Luke's Hospital
Jacksonville, Florida  32216
904-296-5212

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html