Lactation Consultant - Practice & Referral Guidelines

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    Lactation Consultant: Practice and Referral Guidelines WACSClinProc7.1/09May-11

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    SDMS ID: P2010/0696-001WACSClinProc7.1/09 WACS

    Title: Lactation Consultant: Practice and Referral GuidelinesReplaces: Lactation Consultant: Practice and Referral Guidelines 7.1/07Description: Practice and referral guidelines for LGH Lactation ConsultantsTarget Audience: Midwives, registered nurses, medical officers, LGHKey Words: Lactation

    Policy Supported: P2010/0299-001 Breastfeeding Policy

    P2010/0300-001 Breastmilk: Safe Management

    P2010/0299-003 Breastfeeding Protocol

    International Board Certified Lactation Consultants (IBCLC)Lactation Consultant/s employed by the Launceston General Hospital are required to beregistered midwives (RM) with a current practicing certificate with the additionalqualification as a current board-certified Lactation Consultant (IBCLC).

    The primary purpose of International Board Certification is to benefit the public by settingstandards for the care of the breastfeeding mother and her child. The IBCLC credentialidentifies a member of the healthcare team who can provide substantive breastfeeding

    assistance and skilled technical management of breastfeeding problems. After initialcertification, IBCLCs are required to maintain competence and recertify every five years.

    Professional associations world-wide acknowledge the IBCLC credential as theprofessional credential for lactation consultants. There is no other recognised pathway forbecoming a lactation consultant. IBCLCs are required to comply with a Code of Ethics forIBCLCs and to work within ILCA Scope or Standards of Practice.

    Scope of Role:

    Responsible and accountable for the effective co-ordination and standard of patientcare in relation to lactation services provided in the hospital.

    Provides direct nursing care to patients requiring complex lactation intervention whenappropriate.

    Acts as a clinical resource person, makes recommendations and provides advice onmatters relating to lactation services and issues.

    In conjunction with other health professionals provides breastfeeding and lactationeducation for individuals and groups of health professionals and patients as indicatedclinically and by LGH policies and protocols.

    Responsibility for quality improvement activities that relate to infant feeding andbreastfeeding. Specifically, this involves:o In conjunction with Co-director and Baby Friendly Hospital Committee, provides

    professional support for the co-ordination of the Baby Friendly Hospital Initiative(BFHI)

    http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-003http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-003http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-003http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-001
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    o Involvement in activities and committees to assist processes towards ACHSaccreditation within the Womens & Childrens Services and the LauncestonGeneral Hospital.

    Facilitates Outpatient Breastfeeding Clinic for clients requiring additional andspecialised support to two weeks post discharge.

    Objectives:

    Co-ordinate the planning, implementation, evaluation and promotion of lactation

    services within Womens & Childrens Service (WACS) and the Launceston GeneralHospital (LGH).

    Collaborate with members of the multi-disciplinary healthcare team to ensure thedelivery of an optimal lactation service.

    Provide lactation education to medical, nursing and midwifery staff.

    Maintain LGH Baby Friendly Hospital Initiative accreditation, supporting all 10 Stepsto Successful Breastfeeding and the WHO Code for the Marketing of BreastmilkSubstitutes

    Organisation:

    Provides clinical support for the management of complex lactation issues inconjunction with other WACS clinical staff.

    Works autonomously, liaising as appropriate with Nurse Unit Managers and ClinicalNurse Educators within WACS and within the LGH

    Guidance and support is given through the Co-Director (Nursing & Midwifery).

    1.5 FTE Lactation Consultant positions (Registered Nurse Level 3) exist within theLGH.

    Case management model to be utilised as appropriate. Flexibility is required,together with a sharing of the education and administration roles, and collection ofinfant feeding statistics.

    Additional DHHS-employed IBCLCs may be required for holiday relief & study leave.

    Management Plan for Referrals:

    Referral forms are available through the imprest system: Order form no. 114065.

    A referral form is required for all Womens & Childrens Services patients. Theoriginal form must be stored in the medical record.

    Feedback eg Discharge/ Referral form 16E, will be sent to Child Health andParenting Service and / or referral agency directly from Lactation Consultant.

    Referral Guidelines:

    At all times, the mother must have requested or agree to the referral.

    All antenatal referrals should be encouraged to attend an Antenatal BreastfeedingWorkshop. Appointments can be made via computer system into an allocatedAntenatal appointment slot, and a referral sent via internal mail.

    All postnatal mothers referred to the Lactation Consultant should be inpatient or amaximum 2 weeks post discharge.

    Referrals from all other LGH areas eg DEM, 4K are on a requested or needs basis

    Referral form can be given directly to Lactation consultant during working hours, leftin Lactation Consultant folder in ward 4O out of hours, or faxed to LactationConsultant office from other areas (internal no 8924), with a phone call informing ofsame. The original referral form to be left in patient history.

    Those mothers who self-refer or are referred through other sources and are greater

    than 2 weeks postnatal may be assisted via the telephone as time permits theLactation Consultant and if required be referred on to the Family & Child HealthService.

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    Patients with the Extended Midwifery Service (EMS) may be provided withconsultation via the telephone or in the Outpatient Breastfeeding Clinic if EMSmidwives request.

    Mothers who are discharged from care, but are within 2 weeks post-birth may beprovided with consultation via the telephone or in the Outpatient Breastfeeding Clinic.

    The mother should be encouraged to make contact with the Child Health Nurse at alltimes.

    Women experiencing symptoms of mastitis, whether self referred, via community

    health service or physiotherapy referral will be seen in Outpatient BreastfeedingClinic as an urgent case, and an exception to the two week post discharge guideline.

    Tasmanian Aboriginal Centre health worker may refer clients during the antenatal orearly postnatal period, education sessions may be conducted at the TAC asrequested.

    CALD women may benefit from individual antenatal education to increasecomprehension

    Referral Criteria

    CRITERIA FOR REFERRAL TO LACTATION CONSUSLTANT

    INPATIENTMATERNAL CRITERIA INFANT CRITERIA

    Antenatal support where previous breastfeedingdifficulty or specific issue

    Has not attached to breast

    Previous breast surgery - reduction, augmentation,other

    Attachment / suck difficulty

    Nipple trauma, pain or abnormalities Weight loss at or greater than 10% of birthweight

    Nipple shield use and follow-up Premature / sick infant: maternal expressingsupport

    Low supply and/or galactagogue use-Domperidone Supplementary feeds indicated or requested

    Over supply issues Infant diagnosed with congenital disorder(cleft lip and/or palate, Down Syndrome)where mother wishes to breastfeed orexpress breastmilk.

    Breast: pain, flushed, engorged, mastitis, other Breastfed infant admitted to 4K wherenursing and / or medical staff considerreferral will be beneficial.

    Difficulty with positioning of infant due to maternalhealth, disability or well-being.

    Breastfeeding mother admitted to LGH for medicalor surgical issue, where nursing and / or medicalstaff consider referral will be beneficial.

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    OUT-PATIENT

    MATERNAL CRITERIA INFANT CRITERIA

    Extended Midwifery Service (EMS) patients withbreastfeeding difficulties.

    Infants requiring monitoring of weight relatedto breastfeeding issues.

    Antenatal patients with:

    Previous breastfeeding difficulty

    Previous breast surgery eg reduction

    Existing breast anomaly, eg inverted nipples

    Pre-existing condition where breastfeedingmay be affected or antenatal expressingmay be of benefit - diabetes, thyroid,pituitary, allergy, anxiety, disability

    Known foetal anomaly which may impact onbreastfeeding.

    Multiple or preterm birth expected

    Infant with suck difficulty

    Boarder mother requiring breastfeeding review Premature infants transferred to 4N at Homerequiring breastfeeding follow-up.

    Mother using breastfeeding aides such as:

    Nipple shield

    Supply line or finger feed

    Jaundice with associated breastfeedingdifficulties (low supply) or breastmilk jaundice

    Breast or nipple condition, e.g., nipple trauma,mastitis, infection or injury.

    EMS patient with feeding difficulty or weightloss greater than 10%

    Galactagogue use (e.g., domperidone)

    Postnatal patients at discharge with history ofbreast surgery or other complex breastfeedingneeds.

    Community referral for treatment of breast signs orsymptoms, where physiotherapy ultrasoundappears to be indicated.

    The Lactation Consultant will consult with medical staff in any of the followingsituations:

    As required to assist collaborative decision-making.

    Medication or pathology appears to be indicated.

    Maternal or infant health may be compromised.

    If infant observations and health status indicate and/or weight loss is continuingabove 12.5% (Macdonald et al 2003).

    Re-admission appears to be indicated.

    Premature or sick infants in 4N or 4K, where a change of feeding regime is indicated.

    Clinical Decision Making:The Lactation Consultant will consult with midwife, medical staff, physiotherapist,dietician, social worker and other health professionals as indicated, for the purposesof collaborative decision-making and for consultation.

    Where possible, the midwife or nurse caring for the referred inpatient, will be involvedin assessment, planning, implementation and evaluation of care planned.

    The patient is a partner throughout the assessment, planning, implementation andevaluation process.

    The family, when available, will be included in this process

    No plan should be commenced without the patient understanding the risk and

    benefits of the chosen plan and alternatives. Documentation should reflect thisinformed consent.

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    The Lactation Consultant will work within the policies and procedures of theLaunceston General Hospital.

    Follow up Planning:

    Implementation of any clinical plan will require adequate instruction to the patient andstaff caring for that patient.

    A documented time-line for review (e.g., 24 hours) should be given.

    Consideration of the need for a written plan for patient and staff should always be

    made.Notes on assessment, plan, implementation and evaluation are written following eachconsultation in the progress notes.

    Where more complex management plans are required for inpatients eg use oflactation aids, the Lactation Consultant will discuss with the CNC to ensure adequatestaffing.

    A follow up appointment in the Outpatient Breastfeeding Clinic should be made forany patient being discharged using a lactation aid or more complex feeding plan.

    Phone contact to the local Child Health Nurse should be made prior to the dischargeof a patient with more complex needs or requiring prompt follow-up, making themaware of any LC follow up arranged. Always consult with the local Child HealthNurse prior to any referral to Walker House Parenting Centre.

    Lactation Consultants in private practice are available in the northern region. Amother may be referred to a private practitioner for follow-up care if she requests oragrees to same.

    Australian Breastfeeding Association (ABA) information should be available for allbreastfeeding mothers.

    Parentcraft / Antenatal Education:The Lactation Consultant will:

    Provide expert advice and input into the curricula for antenatal education regarding

    infant feeding.Have responsibility for conducting accessible and appropriate BreastfeedingWorkshops for antenatal women.

    Collate and review patient handouts and literature for antenatal and parent educationon infant feeding.

    Staff Education:The Lactation Consultant will:

    Provide regular breastfeeding education to registered midwifery and nursing staff egProfessional Development Day, on ward in-service, access to online learningpackages.

    Provide breastfeeding education to student midwives and medical students asrequired

    Provide supervised clinical practice time for registered nurses, student midwives andmedical students (BFHI requirement is a minimum of three hours for nursing staff)

    Provide new staff to WACS with supervised clinical practice time as part of theirorientation eg Pool staff three hours, WACS staff eight hours

    Provide orientation to the LGH Breastfeeding Policy to all staff working within WACSeg catering and cleaning; and the wider LGH community as appropriate eg On-boarding for new staff, DEM, Theatre, Dieticians, Physiotherapists etc

    Professional Development:Lactation Consultant should:

    Attend a conference or seminar at least annually

    Participate in appropriate professional organisations

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    Receive and review professional journals and other sources of evidence basedpractice and current research.

    Hospital financial support for the above will be decided by consultation with Co-Director(Nursing & Midwifery), Womens & Childrens Services on an as need basis.

    Lactation Consultant Participates in the Following:Launceston General Hospital internal committees

    Baby Friendly Hospital Initiative (BFHI) Working Group as Chair

    Nursing and Midwifery Reference GroupCHAPS & QVMU Liaison meeting

    Statewide Committees representing Launceston General Hospital

    Baby Friendly Hospital Initiative Tasmania Committee

    Tasmanian Breastfeeding Coalition.

    Collection of Infant Feeding Statistics:

    Infant feeding statistics will be collected on all babies who are born in the QueenVictoria Maternity Unit, or the baby is admitted to the LGH during the early postnatalperiod.

    Statistics collected will be as per BFHI requirements or for Quality Activity purposes

    The midwife at the time of discharge is requested to ensure completion ofappropriate section of the Neonatal Clinical Pathway and Infant Feeding StatisticsForm.

    The Lactation Consultant, or delegated person, will collate statistics into designatedcomputer system.

    Monthly summaries will be available and disseminated through the LGH-BFHIcommittee and other committees as appropriate.

    Maintenance and Supplies:

    The Lactation Consultant will:Collect and maintain records of Miele Thermo-Disinfecting Dishwasher situatedbetween Ward 4O and 4N.

    Act as a resource person to work with CNC and other persons responsible for themaintenance and ordering of supplies concerned with lactation aids and infantfeeding.

    Store additional equipment or lactation aids required for complex referrals.

    Maintain knowledge of current and recent developments in regard to lactation aidsand disinfection requirements of infant feeding equipment.

    Together with CNCs, liaise with external company representatives and LauncestonGeneral Hospital Purchasing and Stores personnel, where procurement of infant

    feeding equipment and lactation aids for the Launceston General Hospital isrequired.

    Work within the World Health Organisation (WHO) International Code of Marketing ofBreastmilk Substitutes and subsequent relevant resolutions, and ensure others withinthe LGH comply with LGH Policy regarding this.

    Order office requirements from Supply Department through Ward 4O.

    Glossary:IBCLC International Board Certified Lactation ConsultantILCA International Lactation Consultant AssociationIBLCE International Board of Lactation Consultant Examiners

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    Performance Indicators:

    Review Date: Annually verified for currency or as changes occur, andreviewed every three years.

    Stakeholders: Registered nurses, midwives and medical officers, LGH

    Developed by: Jill Hanson and Dianne Howarth, Lactation Consultant

    Helen Bryan Sue McBeathDirector of Nursing Co-Director (Nursing & Midwifery)Launceston General Hospital Womens & Childrens Services

    Date: 18 June 2009

    References:

    Code of Ethics for IBCLCs, 2006, www.iblce.edu.au

    ILCA Standards of Practice for IBCLC, 2006,

    www.ilca.org/files/resources/Standards-of-Practice-web.pdf

    Scope of Practice for IBCLCs, 2008, IBLCE,www.iblce.edu.au/downloads/ScopeofPractice2008.pdf

    McDonald PDM, Ross SRM, Grant L, Young D (2003) Neonatal weight loss in breastand formula fed infants,Arch Dis Child Fetal Neonatal Ed, 88: F472-F47

    Lactation Consultant Referral Form (stores code 114065)

    Discharge/ Referral QVMU Form (stores code 13540)

    http://www.iblce.edu.au/http://www.iblce.edu.au/http://www.ilca.org/files/resources/Standards-of-Practice-web.pdfhttp://www.ilca.org/files/resources/Standards-of-Practice-web.pdfhttp://www.iblce.edu.au/downloads/ScopeofPractice2008.pdfhttp://www.iblce.edu.au/downloads/ScopeofPractice2008.pdfhttp://www.iblce.edu.au/downloads/ScopeofPractice2008.pdfhttp://www.ilca.org/files/resources/Standards-of-Practice-web.pdfhttp://www.iblce.edu.au/