2/1/2016. LACTATION CARE MAP at CHOC Children s Neonatal Intensive Care Unit. Disclosures. Crystal Deming has nothing to disclose.

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1 LACTATION CARE MAP at CHOC Children s Neonatal Intensive Care Unit Disclosures Crystal Deming has nothing to disclose. Cindy Baker-Fox is an adjunct instructor for the University of California San Diego Extension Lactation Educator Counselor Program Cindy Baker-Fox RN, BSN, IBCLC Crystal Deming RN-NIC, BA, IBCLC Objectives Following this session, the learner will be able to: Verbalize the importance of an NICU Lactation Care Map and its impact on improved lactation services and patient satisfaction. Identify the role of each key NICU team member in the lactation care process. List 3 key educational components to be presented within the first 24 hours post NICU admission. Where we have been. CHOC 1964 CHOC NICU 1960 s CHOC

2 CHOC Children s NICU Free standing children s hospital 279 total beds Adjacent to a delivery hospital NICU Statistics Level IV 67 total beds (including a 12 bed Small-Baby-Unit) Average 775 admits/year (60 SBU admits/year) 42 Attendings, 8 Fellows, Residents 174 NICU RN s Outreach 9 NICU s in 4 counties totaling 219 beds Active outreach program M&M rounds & bi-weekly CHOC speakers CHOC SBU 2010 Focus of Lactation Consultant Service Infants with the longest hospital stay and most complicated courses SBU, Neuro, Surgical, Cardiac Hyperbili admits Mothers with highest lactation failure risk Long term pumping Extreme prematurity Goal: Increase breastmilk at d/c for infants <1500 g & with high risk dx Care Mapping Using the Care Map Goal to improve lactation care and rates through: Consistent messaging among all healthcare providers. Ensuring around the clock availability of information. Promote early and timely initiation of milk expression. Properly utilize the limited hours of the lactation consultants. Outlined key points of lactation care to be provided by the bedside RN and the NICU RN IBCLC. Created algorithm of basic care and delineation of duties. Initial algorithm focused LC time on <1500 g Phase II expanded to <1800 g to capture other high risk dx 2

3 Role of the Admitting Bedside RN Breastfeeding for Success Bundle Give a Breastfeeding for Success Bundle & review contents Pump kit In basin Cooler Pack with Colostrum collector kit Water Bottle Scent Cloths & lovey doll Dot Stickers for 1 st & 2 nd week s breastmilk Breast Pump for Home The Your Milk is Medicine Pamphlet Stress Importance of Early Hand Expression and frequent HOP We recommend Morton Videos & assist as needed Morton, J, et al. Journal of Perinatology. 2009:29, Pumping and Breastfeeding Logs Role of the IBCLC for the Lactation Admit 1. Meet or Call Mom IBCLC Consult 2. Review supplies & info & pump for home 3. Develop a Personal Plan 3

4 Our IBCLC Team ONGOING Lactation Support Daily Skin to Skin Care 1 st PO feed at Breast Pumping & Lactation Support Daily Breastfeeding as po feedings increase EVERYONE is part of our team! IBCLC assisting BF Parents Concurrent Initiatives Volunteers pack BF Bundles Staffing Adjustments (Nov 2012) Staffing shifted to provide 2 lactation FTEs for the NICU. ELBW Lactation Intervention Study (May 2013) Loaner Pump Program Enhancements (July 2013) Milk Lab Medical Team Rounding RN giving BF Bundle Education to physicians & staff Lactation Rounds Antenatal consult scripting Participation in VON collaborate Results of the Initiatives % of VLBW Infants with MBM Available at Hospital D/C Twice yearly CLEC courses on CHOC campus Promotion of IBCLC course to NICU staff Rotating scholarship CLEC or IBCLC courses Resource Team development and training BF and BM goals part of all staff annual evaluation Bixby C, Steele C, et al. BF Med. 2014;9 (supp 1):S-12 Bixby C, Steele C, et al BF Med in press 4

5 Results Presented at ABM 2014 National Recognition Full article accepted for publication in Breastfeeding Medicine January 7, 2016 What s Next at CHOC? CHOC Logs & Equipment Lactation Info changed to purse size & log added within Increasing # & standardizing type of Pumps available for hospital use Increasing # of breastfeeding scales & pillows The SummaryM of Lactation Details..now Total inventory & by day Diet Order Graph of milk type & route IBCLC Charting..next Improved charting Interface other staff charting Add BF Assessment from all staff. Lactation Resource Team 5

6 Tool for Breastfeeding Assessment Breastfeeding Care Pathway: Term Infant Define breastfeeding behaviors Increases lactation knowledge of staff Lists milk supply expectations & interventions Defines intervention needed and when to promote independence Consistency among team members The Goal.. BREASTMILK & BREASTFEEDING!! 6