I just started a new FT job as LC at my local county hosp, the first
of three of us. Two IBCLCs (Admin wants at least one with a CLE) to see
BFing moms wherever we find them, & one (RN / IBCLC) who will primarily
write Policy, but also see moms on the floor. All three of us are to
train staff. Admin is still searching for an LC Program Director (RN,
IBCLC, Master's, bilingual, etc.).
Birth rate is rapidly approaching 500/mo if not there already. I
know, that doesn't compute. Initiation rate is now about 25% - maybe. By
my very informal count, 10% want BF-only, 80% want B&B, 10% want ABM
only. ABM Rep is welcomed every two weeks in well baby nursery ("but
she's nice & she BF'd both her kids"). N-products are all over this
hospital. I visit PP, Well Nsy, Peds, NICU, PICU, Women's Clinic, Peds
ER & will contact Adult ER this week. If no one is asking for me, I go
looking for all BFing moms, then for the B&B mom who are willing to try
BFing in the hosp rather than waiting until they get home. The vast
majority are Hispanic & my Spanish skills are at the preschool level. I
can & do call on translators, but they are usually in a very great
hurry, want to solve the problem & be gone to the next appt. Admin. is
talking about hiring a translator for each one of the 3 of us!! I'm
still learning who people are, both supporters (there are many) &
abivalents (they're keeping relatively quiet), & what the political
culture is.
My question: Currently, I document personal assistance visits
(latch, positioning) on Progress Notes in patient's folder. I'm looking
for suggestions on documenting the verbal / educational / phone visits &
possibly future post partum return visits. Past conference audio tapes
provide lots of ideas, but so far, I'm blazing my own trail. I do have
Marie's excellent book on Prvt Prac protocols etc. Can interested Hosp
based LCs swap ideas on charting & reporting with me? Would also
appreciate suggestions that will help me put this new LC program on it's
best foot forward & sidestep any quicksand. Hosp computerized case mgmt
system is for financials only & does not include medical care. That's
all on paper. I think they are looking at computerizing patient care,
but I have no idea how far into the future that is. If any of your
hospitals have adopted good computer programs, can you share the source
with me, privately if necessary? BTW: the NICU is adamant in its
support & encouragement of breastfeeding. They want anything &
everything the baby's mom can provide.
There are two records in the Well Nrsy: one for mom & one for baby.
They often differ on feeding choice, (i.e. ABM only in one record B&B in
another) & I see something else when I go to her room (BR-only, no help
wanted). This inconsistency of recording is a source of much wasted time
for me in trying to prepare a list of moms to visit. I may even find
that she's already gone home even though she's still in the "mom" book
in the Well Nrsy. That must be the last form to be changed. Also, it
seems that HOW the baby is fed is less important than THAT baby is fed.
They record volume of ABM consumed or minutes at breast and time of day
of each feeding. Every baby gets his very own pacifier. Helps keep the
noise down during the 2 hour shift change Assessments. I did hear one RN
remark that she was glad to see some moms come in to get their babies -
it saves her (the RN) time to do other things. I take that as incentive
to suggest the same to the moms.
In all fairness, this hosp is always understaffed. In spite of the
very heavy workload and 7am to 7pm shifts, these RNs keep a remarkably
pleasant attitude. It is also a teaching hospital, so there are interns
& residents on rotations, with 4-6 babies lined up so they can all
listen to the various heartbeats, and small groups of all kinds of
health care students clustered here and there, usually in doorways or
filling the corner of the nursery. Yet the RNs keep smiling!!
I welcome your thoughts & suggestions, both on the list and
privately.
Phyllis Adamson, BA, IBCLC
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Note that I have a slightly different e-mail address and what shows on
previous postings.
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