We use Epic too and we do not enter the weight until later in the delivery summary. This issue came up at another hospital that I worked for because the OB's complained that they wanted to enter the weight right away. And it was determined that the weight is not really "required" in the OB notes. They are just in the habit of putting it in there. It is not an insurance requirement. It needs to be part of the baby's chart and the delivery summary. The RN will put it in the delivery summary later. It really is best to shoot for no separation from the mom at all. And the point of this is that we begin changing the way that we do things so it's best for the patients and not because it's habit or convenient for us. Epic is usually pretty good about making these requested changes I think. Another barrier that hospitals sometimes encounter is Pharmacy not wanting to dispense meds without a weight or length even though eye ointment and Vitamin K dosage does not change based on weight. That is the more typical problem. I've even heard of some that won't create the infant's chart without a weight. If you do have some legal reason it's needs to be in the OB notes, talk to Epic about having it flow over automatically from the Peds notes or the Delivery Summary. It's my understanding that type of thing is pretty simple for them to change and make it automatically flow over later.
Another problem with bringing baby to the scale for quick weight check routinely is that often it becomes more than just the weight and length and the nursery RN begins trying to just "get a few things done." And then it's much longer. Also, during assessment they will not determine the length of separation from your charting, but on the mother's verbal account of what transpired during delivery. They are going to ask the patient how long the baby was gone from her and if she perceives that it's longer than 5 min, whether it was or not, then it counts against you. Same thing for rooming-in and baby being out of the room for less than an hour per day. It's the parent's perception of time. We do weight checks though for any valid medical reason, suspected chorio where they will need weight to order antibiotics, SGA and LGA suspected to know if we need to begin accuchecks, etc. But in those cases it's a quick weight usually and baby back to mom and we try for under 5 min anyway unless further medical complications.
On a side note, I think it's also imperative for nurses on admission to explain the benefits of STS and that they recommend it at delivery, just letting them know what's going to happen. When we first rolled it out we had a number of nurses that would just plop the baby on mom with no warning or discussion prior, and that was a real patient dissatisfier. Also, they need to know that if mom says she needs a minute, it's okay, that's maternal preference, we don't need to force them to go skin to skin immediately against their will. Just document, document, document, that's critical during assessment for maternal preference or medical indication. I would get that added to your delivery summary in Epic, too. I once had a patient that wanted to get up to the bathroom before an hour of STS was over and the nurse told her no, she needs to finish her STS time - Oh boy! The things you have to spell out to people... I do think most hospitals have 2 RN's at deliveries, one for the mom and one for the baby. But you are right they are pulled in every direction. Good luck with your designation process!
Tricia Shamblin, RN, IBCLC
Date: Tue, 26 Jul 2016 15:22:10 -0400
From: Mandy Schaub <[log in to unmask]>
Subject: Baby Friendly Skin to Skin
For those of you who are in Baby Friendly facilities or on your way, I am looking for some help with our current skin to skin problem. We are Auditing Step 4 and have some concerns. Step 4 basically says baby goes skin to skin with mom within 5 minutes of vaginal birth and remains there until after the first feed or for at least 1 hours uninterrupted. We use Epic for computer charting. Epic requires the baby’s weight be entered in the delivering OB’s note before it can be completed. Typically once baby is born they are going to mom immediately. The issue is about 15-20 minutes in they are being taken away from mom for a weight and then being put back. My understanding is this is considered an unnecessary interruption of skin to skin before the first hour/feeding is complete. I’m not sure that doing the weight immediately after delivery before seeing mom is a solution, because we typically deliver baby and hand it right over. Do we really want to not have mom be the first person to hold her baby or to wait for a weight to do so? No. At the same time the weight needs to be done before the first hour is up. Apparently DHEC requires the weight be part of the delivering Doc’s note. There is probably no way we can get Doc to add it later in an addendum. We are lucky to get the charting we do. How do other people do this??? We've tried putting a towel on mom drying baby off on mom, whisking it away for a weight and returning within 5 minutes to begin uninterupted skin to skin. There is only 1 RN in the room being pulled in 100 directions, so it isn't working. Please share your delivery work flow. How do you get a weight, skin to skin within 5 minutes and uninterupted? Do you utilize a baby RN in addition to your delivering RN? In a perfect world the Doc, computer or charting wouldn't matter, but we have to consider it, so I need a real solution.
Thanks for your expertise, Mandy Schaub
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