As I collect BF initiation data at my hosp, I often find several 'choices'
listed on different documents as to how mom wants baby to be fed. I check
mom's Med Record, baby's Med Record, baby's Nurse's Notes, and baby's
Kardex sent from L&D to the nursery. The Kardex almost ALWAYS shows "B&B",
a green light to feed formula any time baby is in the nursery and it's
"time" to feed. If more than one choice is listed, it's 'Breast/B&B' or
'B&B/ABM'. At times though, I found all three choices. A few times, I found
'Breast' on one document and 'ABM' on another (not B&B). The nurses'
explanation? - mom changes her mind a lot.
We do need to find out who, exactly, fills out the Kardex in L&D or in
Triage. We also need to get the baby's record documented when ABM is fed to
any baby that is "Breast-only" either by mom's choice or by actual
practice, even if the record says "B&B".
So far, we have staff agreeing, grudgingly sometimes, to NOT put ABM in the
crib drawers of 'Breast only' babies. Our concession to this agreement was
to have bottles available at the nurses' station so postpartum nurses don't
have go all the way down to the nursery when mom wants ABM. We haven't been
able to get agreement on this for the 'B&B' babies. This choice makes it
difficult to know mom's real intent. The reality of feeds varies from
ABM-only to Breast-only. Next task: teach staff how to ask the original
question - anything BUT: "Breast or Bottle?" - which brings the usual
response: "Both".
BTW: Why is baby in the nursery? Assessments, hearing test, medical exam,
discharge exam, heel sticks or needles in the back of baby's hand for a
variety of blood tests, Bili lights, mom wants to shower or take a nap, and
just plain waiting their turn because some doctors won't wait for babies to
be brought in from mom's room - often requiring being taken off breast
because "the doctor needs to examine the baby NOW".
--- Phyllis Adamson, IBCLC
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