I decided to use Diane Weissinger's suggestion that when we do request
emails privately as well as to the list, that we follow up with a synopsis
of the private emails received that didn't make it to the list. So here
goes: For the most part, the hospitals that do use gel dressings for nipple
damage/severe soreness do not require a physician's order, just very good
documentation in the notes as to the nature and extent of the tissue trauma,
probable cause and interventions used to remedy the cause (ie, improve latch
and position, individual staff education, etc.). The exception was a
hospital that needed an M.D. order for reimbursment purposes. The LC's are
the only ones with access to the dressings in some hospitals, but the
majority were available (after staff ed.) to all nurses. Most respondees
felt that the gel dressings were overused by the RNs, but this was balanced
by the overwhelmingly positive response of the mothers who love them and use
them for a day or two, generally with no interuption of breastfeeding. I
look forward to the day when we will not need such after-the-fact remedies
for a problem that probably could have been prevented in the first place.
However, there are 100+ nurses and just one part time LC (me!) swimming like
a fish against a big river of old habits and attitudes. Thankfully, the tide
on my units is turning, enthusiasm about breastfeeding is growing and fully
5 of the nurses are going to sit for the IBCLC exam this summer. I am
hopeful for a full sea change. Thank you for all who took the time to email
me and the post. Hope this helps.

Kimberly Jackson, RN, IBCLC
Not so sunny Oregon (but lush and green and begining to burst into bloom!)

             ***********************************************
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