That's what we did. We made a set of nursing care plans for the LCs to use, and now the RNs, as our staffing was cut drastically two years ago. They are very basic and allow for a contract between patient and caregiver that she has a set of instructions to follow for any given problem, such as "the baby who doesn't latch on", or "initiating a milk supply with an electric breast pump." They also give the mother a written plan, as many women do have trouble remembering what we tell them (postpartum women only remember 10% of what you tell them--and the mothers agree when I tell them that!). They are in duplicate and have places for mother and caregiver to sign. At the very least, an RN can initiate a care plan until an LC comes in in the morning. They don't have to wait for an LC to get care started, which saves precious time in the usual 48-72 hour hospital stay. If the care plan has been started, it can give us valuable information from which to work or at the very least, minimize or prevent engorgement, get pump rentals started, maximize milk supplies for NICU babies. It is also a learning tool for the nurse--she'll eventually have to learn about breastfeeding if she keeps initiating care plans!!
Maureen Allen RN, BSN, IBCLC
Brigham and Women's Hospital
Boston, MA
-----Original Message-----
From: [log in to unmask]
To: [log in to unmask]
Sent: Thu, 5 Jan 2006 07:49:31 EST
Subject: Lactation Services Protocols
Becky has asked about the need for her to utilize lactation protocols in her
institution. Do you know why you were asked for these? It could be that
there are a number of reasons for such a request: Joint Commission wishes to
see
these, hospital liability issues whereby care must follow established
guidelines, patient complaints of inconsistent information, etc. What you might
find
helpful instead of rigid protocols is the use of clinical algorithms, flow
charts, or decision trees. These allow for the many variables that are part of
managing breastfeeding situations and problems. These allow the clinician to
ask a question and follow a path depending on the answer. While our work is
fluid with many variables, if you have to put it onto paper, this may be a
reasonable accommodation. There are many of these in use, some of which have
also been published. Many of us use them as models to create our own.
Marsha Walker, RN, IBCLC
Weston, MA
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