Great discussion about the different tools.

As most presenters have mentioned the need to come up with
something meaningful that will fit into those little boxes on
the nursing forms has been a driving force behind much of these
tools.

As an alternate solution we are changing our form.

At present our nurses have one box on the maternal/infant flow
sheet to chart feeding.  Actually two boxes - one on the mum's
side to chart on her breasts and one on baby's side to chart on
method of feeding. Other than these boxes all breastfeeding
charting must be done on the nursing notes.

I am pleased to be involved with the creation of a new form for
our public health nurses for breastfeeding charting.  It is one
page for just breastfeeding.  For each topic it includes an area
to chart assessment, intervention and evaluation.

The topics are: mum's position, baby's position, latch, suck,
supplements/pacifiers, milk supply/letdown, breasts and nipples.

Staff can check the box if everything is great.  If there is a
problem, they put an X and can write in the boxes or chart on
the back. Then they would move to the next column and give
interventions. Then the evaluation column where they can chart
stuff like: no pain with deeper latch, mum able to replicate
latch on her own, needs reinforcement, no nipple compression.

There is another area for health teaching that includes various
topics to be checked off as needed.  There is room to record a
weight and when/how client will be followed up.

The back of the form has a section with our regular nursing
notes for narrative or SOIE charting (Subjective, Objective,
Intervention, Evaluation) if needed for more details, and a Plan
of Care section to detail what mum will work on or the
suggestions that were given to mum.

So far we have been perfecting the format and testing the form
with a few nurses who have loved it.  We are launching it with
the whole team of 40 nurses in March, with the requisite huge
set of guidelines of course.

I am hopeful that this will get nurses looking at the many
aspects of each feeding. And of course,  this charting form is
only one part of a bigger educational plan.

Janet Vandenberg RN, BScN, IBCLC

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