The following notes are from the Mother Baby Summit Conversation Cafe round-tables.

 

1)  Rooming-In – Bryson McHardy, MD & Amy Bue, RN (Hannibal Regional Hospital) 

  • Safety is important.
  • Need to get physician buy-in. Many physicians find rounding is more efficient.
  • Staffing issues need to be considered.

 

2)  Skin-to-Skin in the OR – Courtney Barnes, MD (Women’s & Children’s Hospital)

  • Criteria for S2S
    • BFHI says “when mom is stable.” How does your hospital define “stable”?
  • Need to develop system for transferring mom/baby dyad from OR table to bed.
  • Need to staff baby in the OR. Can’t be mom’s RN or the anesthesiologist.

 

3)  Skin-to-Skin after a Vaginal Birth – Sandra Ahlum, MD (Hannibal Regional Hospital)

  • Requires RNs to change their routines.
  • Increases patient satisfaction.
  • Require documentation for S2S times.
  • Some physicians want a baby weight so they can complete their charting.
  • Some physicians want baby bathed. Benefits of waiting 8 hrs for bath.

 

4)  Pacifier Predicament – Debbie Smith, RN (Fitzgibbon Hospital)

  • Teach RNs to soothe babies using other techniques so they can teach moms.
  • Hearing screening can be done while mom/baby are S2S.
  • Teach prenatally so parents don’t expect pacifiers and don’t bring their own.

 

5)  Purchasing Formula – Beth Sevart, RN, IBCLC (Truman Medical Center – Hospital Hill)

  • There’s a perception that it’s more difficult for hospitals with a pediatric unit.
  • Determine the actual monthly usage of formula vs formula given away.
    • May mean moving formula to Pyxis.
    • Using informed-consent form may decrease usage.
  • Partner with Administration/Purchasing/Central Supply to determine a fair market price.

 

6)  Banning the Bags – Kimberly Hamlin, MD (Barnes Jewish Hospital)

  • Sometimes pediatricians want families to have formula as a back-up plan. Home health or WIC can make follow-up calls to help with breastfeeding instead.
  • Some patients expect bags. They can call the number on the bottom of the coupon.
  • Limit access to formula in the hospital (Pyxis or a locked cabinet).

 

7)   Getting Nurse Buy-In – Diane Bibb, RN, IBCLC (Hannibal Regional Hospital)

  • Find role models for new behavior. Early adopters talking to their co-workers helps with buy-in.
  • Give the nurses the opportunity to brainstorm and problem solve how to change their workflow to encompass the new practice.
  • Patient-Centered Care vs Nurse or Dr. Centered Care.
  • Change takes time. Start with one small change using PDSA cycles. Celebrate successes!!

 

8)  Using Donor Milk – Tamara Fusco, MD, IBCLC (Mercy Hospital – Springfield)

  • Increases rate of exclusivity for CMS/Joint Commission for well babies.
  • Sullivan & Schanler’s paper justifies use of donor milk in NICU
  • May need to educate staff and parents on processing of donor milk to get over the “ick” factor.

 

9)  Meeting Breastfeeding Education Requirements for Staff – Natalie Lavelock, RN, IBCLC  (Fitzgibbon Hospital)

  • Get creative and have fun.
    • Songs (“What Would the Nurse Say?”)
    • Cupcakes
  • Create educational tools for staff to use with moms in OB clinic.
    • Book
    • Handouts
    • Lactation visits
  • Use online platforms for education.
    • Don’t over-teach.
    • Consider adult learning styles.
    • Use lactation clinic.

 

10) What about Supplementation? Barbara Philipp, MD, IBCLC (Boston Medical Center)

  • Make sure hospital systems are not the cause of the need for supplementation.

Eg, Early bathing makes baby cold -> decreases blood sugar -> need to supplement

  • Download ABM’s protocol on supplementation for physicians who are poorly trained in lactation medicine.
  • Have a supplemental feeding plan to follow, so order can simply say “Implement supplemental feeding plan.”
  • Sample plan:
    Encourage mother to breastfeed on cue or at least every three hours.
    Pump after every feeding or at least every three hours.
    Feed baby:
    up to 10 ml/fdg (0-24 hrs of life)
    up to 20 ml/fdg (24-48 hrs of life)
    up to 30 ml/fdg (48- 72 hrs of life)
    Use alternative feeding method of mother’s choice (cup, spoon, syringe, etc)

 

11)  What about Prenatal Education for Parents? – Heather Yocum, RN, IBCLC (Truman MedicalCenter – Hospital Hill)

  • Enlist champions.
  • Be creative with resources (eg, Family Feud)
  • Continue education with new staff. Have annual audits.
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