Faculty Disclosure. SOAP, LATCH or IDK? Law and Ethics of Lactation Documentation. What governs IBCLC charting and documentation?

Transcription

1 Faculty Disclosure SOAP, LATCH or IDK? Law and Ethics of Lactation Documentation Abington Memorial Hospital Staying Abreast Conference Abington, PA October 16, 2014 Presentation by Liz Brooks JD IBCLC FILCA As a lactation consultant in private practice, I charge one fee for the consult, whatever supplies are used. I have no retail operations. I work in private practice (doing home visits), in a large hospital with a Level III NICU (rounding on all postpartum breastfeeding mothers), and at a non-profit community-based breastfeeding clinic with a sliding-scale scale fee. I have written a book, and one chapter in each of three other books, about legal and ethical issues for the IBCLC. I am Secretary of the United States Breastfeeding Committee (Aug ), and a consultant member of the Go-To-WIC Task Force (Nat l WIC Assn) All content of this presentation is my own, and my appearance is not paid by any commercial entity. 2 Objectives (60 minutes) Define one rationale each for charting breastfeeding under baby, mother, or both Describe one evidence-based breastfeeding assessment tool Provide two examples of objective charting when recording mother s subjective statement My nipples hurt Identify which element of the IBLCE Scope of Practice for IBCLCs covers charting and documentation 3 What governs IBCLC charting and documentation? The policies and procedures of your institution IBLCE Code of Professional Conduct for IBCLCs IBLCE Scope of Practice for IBCLC Certificants IBLCE Clinical Competencies for the Practice of IBCLCs ILCA Standards of Practice Federal, State laws or regulations? HIPAA, HITECH Mandated reporting Programs or designations (Joint Commission; BFHI)? 4 Mandatory Charting Documents Image: Workplace policies IBLCE Code of Professional Conduct (1 Nov 2011) These are your rules -- your musts Mandatory! Freely downloadable at 5 Image: 6 Conference attendee only 1

2 IBLCE Code of Professional Conduct Principle 4: Report accurately and completely to other members of the healthcare team. Every IBCLC shall: * 4.1 Receive a client s consent, before initiating a consultation, to share clinical information with other members of the client s healthcare team. 7 IBLCE Scope of Practice for IBCLCs (15 Sept 2012) IBCLCs have the duty to Another must Mandatory! Freely downloadable at 8 IBLCE Scope of Practice for IBCLCs IBCLCs have the duty to report truthfully and fully to the mother and/or infant s primary health care provider and to the health care system by: * recording all relevant information concerning care provided and, where appropriate, retaining records for the time specified by the local jurisdiction. SOP p. 2 9 ILCA Standards of Practice for IBCLC Lactation Consultants (Dec 2013) These are your shoulds -- your goals Voluntary Freely downloadable at Members Only side Image: 10 ILCA Standards of Practice 2.1 Work within the policies and procedures of the institution where employed, or if self-employed, have identifiable policies and procedures to follow 2.5 Maintain records according to legal and ethical practices of the geopolitical and work setting. IBLCE Clinical Competencies (15 September 2012) These are your rules -- your musts really? Mandatory! Freely downloadable at Competencies.pdf 11 Image: 12 Conference attendee only 2

3 IBLCE Clinical Competencies 4. The IBCLC has the duty to report truthfully and fully to the mother and/or child s primary health care provider and to the health care system and will: * obtain the mother s consent for obtaining and disclosing of information as needed or as specified by local jurisdiction * provide written assessments as required * maintain documentation of all client contacts, assessments, feeding plans, recommendations and evaluations of care * retain records for the time specified by the local jurisdiction 13 Let s Teach BFg! 14 Image: Dollar Stock Photo To Whom Is the Duty of Care Owed? IBLCE CPC (must) IBLCE SOP (must) ILCA Standards (should) Mother as patient/client of Introduction, para. 3 Duty para. 3 Preface IBCLC Preamble, para. 1 Duty para. 4 Standard 1.4 Preamble, para. 2 Duty para. 5 Standard 1.5 Definition 5 Duty para. 6 Standard 2.3 Principles Overview Duty para. 7 Standard 2.4 Principle 1.1 Duty para. 8 Standard 3 Principle 1.2 Standard Principle 1.3 Standard Principle 3.1 Standard Principle 3.2 Principle 4.1 Principle 4.2 Principle 5.3 Principle 6.3 Infant (or) child as Introduction, para. 3 Duty para. 3 Standard 1.4 patient/client of IBCLC Preamble, para. 1 Duty para. 4 Standard 1.5 Preamble, para. 2 Duty para. 5 Standard 4.1 Definition 5 Duty para. 6 Principles Overview Duty para. 7 Principle 1.2 Duty para. 8 Principle 3.1 Principle 3.2 Principle 4.2 Principle 5.3 Principle 6.3 Breastfeeding relationship as Introduction, para. 3 Duty para. 3 Standard 1.5 concept protected by IBCLC Preamble, para. 1 Duty para. 4 Standard 1.8 Principles Overview Duty para. 5 Standard Duty para. 8 Standard 4 Standard 4.1 Standard 4.2 Standard 4.4 Standard 4.5 Examples of legal/ethical issues: BF charting Privacy and confidentiality Rights of unmarried couples Minor parents (medical emancipation vs. custody/visitation it ti vs. guardianship) In USA: HIPAA and HITECH (electronic & reimbursement aspects) Teaching breastfeeding vs. teaching formula preparation (BFHI) Teaching risks of not breastfeeding! 16 Risks of Not Breastfeeding Not even five bucks! ore/category.cfm?category_id=9 ILCA Clinical Guidelines for the Establishment of Exclusive Breastfeeding (2014) ILCA Clinician s Breastfeeding Triage Tool (2014) 2more cheap, evidencebased goodies! Conference attendee only 3

4 Evidence-based assessment tools Limitations Language/description/observation/opinion Interrater reliability NICU vs. well baby nursery How do you measure it? 19 Evidence-based assessment tools You need to measure exclusive BFg USA: Joint Commission Perinatal Care Core Measure (1 Jan 2014) USBC: Implementing The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding (2 nd rev. ed.) You need to use electronic health records HIPAA/HITECH/CMS USBC: Best Practices Guide for Implementation of Newborn Exclusive Breast Milk Feeding in Electronic Health Records EHR-Best-Practices-Guide-2014-USBC.pdf plementing-tjc-measure-ebmf-2013-usbc.pdf Evidence-based assessment tools Examples of different tools LATCH (latch-audible swallow-type of nipple-comforthold) IBFAT (Infant BF Assessment Tool) (readiness to feedrooting-latching-sucking) Via Christi (modified from LATCH and IBFAT) PIBBS (Preterm Infant Breastfeeding Assessment Scale) MBA (Mother Baby Assessment Tool)(signaling-positionfixing-milk transfer-ending) NOMAS (Neonatal Oral Motor Assessment Scale) (complex) research/mami Conference attendee only 4

5 Not a rave review of any Overall, few of the tools were sufficiently versatile to be used across community and hospital contexts without substantial modification. MAMI Project Report, p ami-chapter-7-review-ofbreastfeeding-assessmenttools.pdf J Perinat Educ Winter; 15(1): This review demonstrates that a variety of instruments are being used both in clinical practice and in research to assess breastfeeding. Many of the research instruments are lengthy and complicated to score, making them difficult to use in clinical practice. However, many of the instruments have variables in common, and some have been shown to predict breastfeeding duration when collected very early in the postpartum period LATCH Via Christi Really? Conference attendee only 5

6 Electronic Charting The charting we love to hate USA: requirements under HIPAA and HITECH to convert to EMR CMS financial i incentives to use EHR Facilities seeking BFHI designation 31 SOAP for BFg activity Descriptions of pain and latch Effective feeds without timing Baby fed well per mom? Wide mouthed latch with visible ibl jaw movements? Other viable indicators of BF success? Diapers Baby state/demeanor Mother s self-efficacy 32 SOAP for BFg activity It s not charting it s good healthcare Poor indicators of poor feeding Weight loss alone (edema!) Length of time at breast Few diapers in hospital No audible swallows 33 Mother-centered care Building rapport Boosting confidence Creating maternal self-efficacy 34 Summary Charting and documentation rules are governed by P&P at your job, your practice-guiding docts, and the law Mother, baby and the dyad all need assessment Evidence-based tools exist to monitor and record BFg; each has limitations Nothing beats face-to-face communication With the patient/client With colleagues 35 Thank you! Works Consulted: See separate handout Questions? Comments? Corrections? Liz Brooks, JD, IBCLC, FILCA liz.brooks@yahoo.com FB: 36 Conference attendee only 6