Disclosure Breaseeding Telephone Care · PDF file5/15/17 1 Breaseeding Telephone Care May 25,...
Transcript of Disclosure Breaseeding Telephone Care · PDF file5/15/17 1 Breaseeding Telephone Care May 25,...
5/15/17
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Breas+eedingTelephoneCare
May25,2017,Duluth,MNPamelaHeggieMD,IBCLC,FAAP,FABMSheilaHumphreyRN,IBCLCKarinKishel,RN,CLE
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Disclosure
• WehavenofinancialorethicalconflictstodeclarerelatedtothiseducaPonalacPvity
Objec'ves
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1.Outlinegeneralprinciplesofbreas+eedingtelephonecare2.IdenPfyreferencesandresourcesavailableforprimarycareclinicstousefortelephonetriageandadvice3.Discussbreas+eedingtelephonecarecaseexamples
WhatisBreas+eeding“TeleCare”MulPpleopPonsforcommunicaPonØ Telephonecalltoclinic-OB/Peds/FPØ MyChartorsimilarEMRportalØ Hospitalpost-dischargecallbackprogramØ WarmLine,CallstoLC,WICpeercounselingcalls,LLLorothercommunityorganizaPon
LearnyourscopeofpracPceandclinicprotocols
CommonBreas+eedingTelephoneConcerns
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• DoIhaveenoughmilk?• CanIbreas+eedwiththismedicaPon?• “Isitoktobreas+eedifX?”• Crying/fussybaby• Stoolingissues,poopcolor• Mombacktoworkanddaycareissues• PumpingquesPons• Sorenipplesorbreastpain• Sleeping(ornot)
PrinciplesofBFTelephoneCare• Listen!!AcPveandempathiclistening• Restatewhatyouheard• ClarifywithopenendedquesPons,verifythe“concern”• KeepyourobjecPvity...HaveanopenmindforallpossibiliPes• Gathermoreinfo-learnageofbaby(andgestaPonalage),what/how
isbabyeaPng,fever,sorenipples,breastpain,eliminaPon,bealertformentalhealthissues...
• Reviewchart-WCCrecently?,missedappts,previouscalls• Assesscaller’slevelofconcern-whyaretheycallingnow?• Decideifvisitisneeded–when,where,who?• GiveImmediateBreas+eedingPps–duringtransiPonbefore
beingseen,espifnottoday• Reviewplan-includingf/u-officevisit,phone,MyChart,email
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ClinicReferenceBooks HospitalPost-DischargeTelephonecallbackprogram
Telephonecallbackprogram
• Whodoescall?-skilledlactaPonstaffathospital• Calleverybreas+eedingmother2-3daysajerdischarge,soonerifindicated
• UseEMRtogeneratelistofdischargedmothersthatisshareablewitheveryoneresponsibleforcalling
• Plantomake2alemptstocall.Documentoutcome• ProvidePhoneguidanceandclearrecommendaPons• DifferentthanptsaPsfacPon/QIcallback-differentgoals
Telephonecallbackprogram-Benefits
• Safetynet:– catchbabiesnotpooping,notlatching,motherswithnippledamage,engorgement,milkdelay
• Safetynet:– Latepretermandearlyterminfants
• Preventreadmission
• Preventsprematureweaning• Anotherpointofcontactajerdischarge• BigmPINCscore!!
Case1-Frontdesk:“amomhasaquesPonaboutbreas+eeding”
• “Mybabyisveryfussy–she’scryingnon-stop-andIthinkshe’sconsPpated.Shehasn’tpoopedfor2daysandIdon’tthinkIhaveenoughmilk”– Whataretheimportantnextsteps?– WhatinformaPondoyouneedtogatherbeforemakingaplan?
InformaPontoGatherBeforespeakingtoparent
• ReviewChart• Checkageofbaby• CheckGAB(gestaPonalageatbirth)• LastofficevisitdateandinformaPon
– Growthchart– Providernotesregardingmedicalissues,feeding,jaundice,parentalconcerns
– DateandPmeofnextvisit-Appointmentmadeorneeded?• Slowdown...getreadytospeaktoparent
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InformaPontoGatherSpeakingwithparent
• Hearparent'sconcerns• GatheraddiPonalinformaPon• Breas+eedingquesPons:
• Howojenisbabynursing?• Howlongdoesbabynurse?• Areyouabletoseesuckingandhearswallowing?• Doyouhavesorenipplesorbreasts?
• EliminaPon:• Howmanypeesandpoops?
Ø SpecialnoteofcolorofurineØ Colorandconsistencyofstool
• Howdoesbabyseem?• Awake,content,crying,sleepingalot?
• Whathaveyoudonesofar?• Whatmadeyoucallmenow?
MakingaPlan
• RefertoBFtriagebookorotherreference• Useyournursingjudgment• Speaktoprovider,ifneeded• Ifbabyisnewbornneedstobeseeninclinicwithin24hours
– Ifjaundiceconcernsinpastorintelephonecalltodayoranyconcernsaboutdifficultytoarouse
• SpeaktoproviderwithinformaPongathered-chartandparent’sreport• Whenisappointmentavailablewithprovider?
• Iflateindayornoprovideravailableandbaby’sbehaviorisconcerning,togotoED
• Ifbabyhasbeengrowingwell,eliminaPonisnotconcerning,baby’sbehaviorisnotconcerning,bringinfornurseweightcheck– Providervisitmaybeneededforparentwithconcerns
Case1-FussyBabywithnostoolx2days
Doesbabyneedclinicappttoday,ER,homecare,reassurance?• Babyneedstobeseentoday
– Ifagelessthan2weeks-veryconcerning• Whenamomsays“Idon’thaveenoughmilk”
– seetoday(orsoon)forweightcheck• Baby“fussy”...think?sickbabyandseesoon• Ifolderbaby-greaterthan1mo-reassuranceIFrecentclinicvisitwithokgrowth
• Don’tuseconsPpaPonguidelineforBF?sJ
Case2-PrenatalCare Ø ApregnantwomanG1P0at34weekscallsthenurse-linewithbreasBeedingconcerns
Ø Shehadbreastimplants4yearsagoandisconcernedthatshewon’tbeabletobreasBeed
Ø ShewondersifitisevenworthtryingtobreasBeed
• Howwouldyouadviseher?
Case3–pharmacistsaidnottobreas+eed
• Mother/paIentcallsbecauseshewasjusttoldbypharmacist“nottobreasBeed”whiletakingfluconazoleforvaginalyeastinfecIon
• 6weekoldbaby,G1P1,6wkpostpartumvisit• FluconazoleprescribedbyMD
– CanIsIllbreasBeed?– ShouldIstopthemedicaIon?– Whatwouldyoudonext?
Lookitup!Meds&Mom’sMilkLactMed
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BreasBeedingandMedicaIons
• Lookitup!• References
• MedicaPonsandMother’sMilk&LactMed(NIH)
• AskMDs...andmakesuretheylookituptoo!• CommonmedicaPonquesPons–lookitup!
– Cough,allergymeds– AnPdepressants– Anesthesia/surgicalprocedures– CT/MRIscans
Case4–cliniccall
• PaIent-34yoG1P1• 3monthspostpartum-callsinwithfeverof101degreesx2days,feelslikeshehastheflu.Hasmildrunnynose
• Sheisconcernedthatshehasavirusandthatherbabywillalsogetsick.CanshekeepbreasBeeding?Hermother-in-lawthinkssheshouldstopforafewdaysandstayawayfromthebaby
• Babyjuststartedtosleep6hoursatIme– Whatdoyouthinktheproblemmightbe?
– Howwouldyoucounselthismother?
Case5–daycare&bolles• Baby4mo.Momhasbeenbacktoworkfor2weeksandisconcernedthatsheislosinghermilksupply.Sheusedtobeabletopump4-6oz,nowonlygets3-4ozeachImeshepumps
• DaycareprovidersaysbabyissIllhungryaZera4ozbo[leandwantsthree6ozbo[lesratherthan4ozbo[les/day.Suggestedusingformula
• Babysleeping7hoursatnight,andseemssaIsfiedaZerfeedsathome.Feeds7-8/day
• Mompumpsonceatworkfor30minutesoverherlunchhour
Case54mo-daycareandbolles
• Isthereaproblem?• Whatwouldyousuggesttothismother?
_________________________________• Babyseemstobedoingfine• Mommayhavedecreasedmilksupply• LactaIonconsultantmaybeneeded• InmeanIme:gathermoreinformaIon...
Case5-daycare&bollesGathermoreinfo....Reviewchart• Birthweight8lb6oz,Babynowweighs14lbs,followinggrowthcurve,“normalgrowth”perMDnote
• Talkwithmomaboutplan....co-createtogether– Howojenisshepumping?– Whendoesshebreas+eed?– Cansheaddmorepumpsin24hrs?– Pumpmoreatwork–forshorterPme(2-3x)– Considermini-pumpsonweekend,?nightpump– 4ozbolleisok–babydoesnotneed6ozofEBM
BreasBeedingTelephonecare:Commonissuesforage
• NB–latch,sorenipples,jaundice,stools,engorgement
• 1mo–fussiness,bolleintro,pacifier• 2mo–“consPpaPon”normalvariaPonofbreastfedstool,
preparingforworkreturn,storingmilk
• 4mo–distractedbaby,mombacktowork,milksupply
• 6mo–solidsintro,biPng• 9mo–decreasedinterestinnursingwithmoresolids,biPng
• 12mo–weaning,cow’smilkintro
• 2yrs–weaning,tantrums,family/publicpressuretowean
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Summary-“Pearls”ofBFTeleCare
• Listenandlistenagain...• Keepanopenmind• Slowdown• Don’thesitatetobringbabyandmominforvisittoday...orsoon
• Helpbuildconfidence• Useresources–BFtriageprotocols,Meds&Milk• Arrangeforandencouragef/ucalls• Listenformentalhealthissues,copingskills• Thinkbeyondthetelephone....
Breastfeeding Telephone Care Heggie, Humphrey, Kishel May 25 '17