After our children's hospital decided, after a one year trial, to
restructure lactation services from a centralized department into one
NICU FTE and and FTE in another department, I have had the recent (and
wonderful) opportunity to be hired into a part time position as a NICU
lactation consultant.  As a result, I was granted permission to develop
a new program (what fun!) which I'm happy to say has full support of all
disciplines on the unit (including STRONG support by our WONDERFUL
neonatologists --- a dream come true!) Part of the reason for this great
support directly related to the fact that representatives from each of
the disciplines were invited to have input and review the materials as
they were being developed.  The other part is that we simply have great
people at our hospital! :) A "Letter from Your Baby's Doctor" is the
introductory point for each mother. "We now have a second part-time LC
(now making 2 part time positions which average a little over 40 hours
per week over 6-7 days of coverage).    All components of  the program
were officially implemented in full about 2 weeks ago (although some
aspects were introduced a few weeks before).  Already, we have had 3
mothers, who had orginally said they wanted to formula feed, change
their minds and start pumping, even two weeks "out".  Of these, two say
they wanted to "try breastfeeding". Even before the full program was
implemented, there has also been a significant jump in overall
"breastmilk babies" rates (many of our babies are transferred back to
level 2 nurseries before breastfeeding actually begins, or has JUST
begun. OK, I'm through gushing, but those of you who have "been in the
trenches" for years can appreciate my delight.

One challenge was to devise a system which minimized the chance of
"inappropriate breast milk administration" (i.e. one mom's milk to
another mom's baby!).  When I saw the discussion about labeling, I
thought it might be worth the effort to toss out a caution.

We use sterile specimen cups in our high-risk NICU.  For a period of
time, the mothers had been writing the baby's last name, date, and time
of collection on the label enlcosed with the cup.  An obvious problem
was the occasional "Smith" and "Smith" or "Brown" and "Bowen", etc.  You
can see where, especially considering the variations in handwriting, the
potential for such a problem exists. With excellent input from the
nursing director and operations team members and education coordinators,
we are now using a four point check system. preceded with the mothers
being given a set of labels stamped with the baby's name, medical record
number, etc.  After she pours the milk into the cups, she places the
"hospital" label on the cup, writes the date and time.  Each bin in the
freezer also has the hospital label attached to the larger name card.
The medical record numbers are matched before placing the cup of milk
(enclosed in a zip-lock bag) into the bin and also when removing the
milk from the bin.  They are again matched with the bedside record when
warming the milk, and one more time before administering the milk.  At
this point, the RN makes the appropriate check mark in the feeding
column of the chart and intitials that the medical record numbers as
well as the name match.  This method provides several check points,
minimal, but adequate documentation, and the time of only one nurse.
The key to the system is the stamped label bearing the MR #.  (The
system is adjusted for mothers of multiples).

If your hospital is using labels enclosed with whatever container is
used for storage, you may want to take a critical look at the issue of
possible milk mix-up.

Sandy Hess