Transcript Lactation Consulting April 24 & 25, 2015 Presented by

2015 User Conference
Lactation Consulting
April 24 & 25, 2015
Presented by:
Beverly Curtis, DNP, PPCNP-BC, IBCLC
BJ Bloom, EHR Training Specialist
EHR Workshop
2015 User Conference
Beverly Curtis, DNP, PPCNP-BC, IBCLC holds a Doctor of Nursing
Practice degree from Chatham University in Pittsburgh,
Pennsylvania. She is employed as a Pediatric Nurse Practitioner at
Kids Plus Pediatrics. She is the Executive Director of The National
Breastfeeding Center, a for-profit consultation group focusing on the
business of breastfeeding. Beverly serves as Chair of The United
States Breastfeeding Committee. Dr. Curtis mostly likes to help
others learn how they can be successful in supporting breastfeeding
mothers and their infants in a primary care setting.
Poll… Is your system ready for today?
Have you Uploaded?
❏ the modified Breastfeeding
Templates
❏ Yes
❏ No
❏ the Phrase Construction
Notebook
Have you Created?
❏ the baby patient to chart on
❏ Yes
❏ No
❏ the mother patient to chart
on
❏ Yes
❏ Yes
❏ No
❏ No
2015 Office Practicum User Conference
Scheduling:
▪
▪
▪
▪
▪
Does your office schedule Mom and Baby?
Are they Double Booked?
Baby on Provider’s Schedule?
Mom on LC’s Schedule?
Mom and Baby on Provider and LC Schedule?
2015 Office Practicum User Conference
Tracking Patient Status:
▪Patient Waiting
▪Nurse in Progress
▪MD: Patient Waiting
▪ do your patients see the MD?
2015 Office Practicum User Conference
Applying the Templates:
▪ Who sets up patients?
▪ Who applies templates?
2015 Office Practicum User Conference
Template Components:
● Orders/Workflow
○ What meds do you frequently write for?
○ Common Labs - ie: Bili
○ Patient Ed: Handouts - incorporate your own as
Standing or Alternate orders
○ Surveys:
■
■
■
■
■
Edinburgh
Hazelbaker
Breastfeeding Assessment
LATCH (would need to create)
Pain Assessment Scale (would need to create)
○ F/U: Orders for follow-up visits
○ Other: Referrals - do you frequently write the
same order for referral?
●Review/Edit Phrase Construction Notebooks
2015 Office Practicum User Conference
Visit Info:
▪ When do you
apply rendering?
▪ Does IBCLC
choose?
▪ Do you allow it to
auto-populate
when the provider
documents in the
note?
2015 Office Practicum User Conference
Charting Tips:
● HPI: the perspective of the mother or the baby
(most can be copied from mom to baby)
2015 Office Practicum User Conference
Charting Tips:
● Charting History
○ understand OP14 genetic history linkage
○ importance of Gestational Age
2015 Office Practicum User Conference
Charting Tips:
● Entering Pre and Post Weights (WL%)
● Use of Comments field in Vitals
2015 Office Practicum User Conference
Charting Tips:
● Use of Phrase Construction to Document
2015 Office Practicum User Conference
Charting Tips:
● Clear guidelines as to which parts of ROS the LC
will chart and what is for provider
● Use Copy and Paste Feature
2015 Office Practicum User Conference
Charting Tips:
● Layering the use of templates
1. The templates can be
accessed at any point while
charting.
2. Choose “Breastfeeding”
from the template drop down
list.
3. One of the first 4
will be applied to start
visit.
2. Layer the other
template to facilitate
charting.
2015 Office Practicum User Conference
REMINDER:
If you need to leave an encounter:
1. Select EXIT
2. Choose Save
Practice Policy
Question: are your
templates set so only
Providers can
choose to “Save and
Finalize”
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Let’s
See It!
2015 Office Practicum User Conference
Let’s
Try It!
2015 Office Practicum User Conference
Case Study:
19 day old infant presents with feeding and latch difficulties resulting in maternal sore nipples.
Infant is the 10# 3 oz. product of a postdate gestation to a 33 year old G1P1 mother.
Antenatal course was uncomplicated, resulting in an induction for postdates. Normal, vaginal
delivery without complications. See newborn history for details. In the hospital, there were no
problems with glucose, temperature instability, jaundice. The baby nursed within the first
hour of life and nursing went well in the hospital.
Milk came in by the evening of day 2. Mother reports breasts were very engorged and baby
had trouble with latching. Sore nipples developed. Present treatment consists of a
commercial nipple butter. Left nipple is cracked, scabbed with a small fissure at the base. At
day 12, mother reported achy, red, tender left breast. She was placed on antibiotics by her
OB. Mastitis symptoms have resolved, yet nipple pain remains. Baby is nursing every 2 to 3
hours. Due to left nipple pain, mother has not offered the left breast for the past day- she is
pumping only on that side.
2015 Office Practicum User Conference
Case Study:
Infant Vitals:
Infant Birth Weight 10# 3 ounces
Infant Weight Today 11# 8 ounces
Infant Length 22.50 inches
Infant HC: 38 cm
Infant is not currently taking any medication
Maternal vitals:
Maternal BP 115/72
Pulse 75
Temp: 98.7
Maternal medications:
Chronic: armour for thyroid
During pregnancy: prenatal vitamins
Present: prenatal vitamins, armour for thyroid, dicloxacillin 500 mg, qid, motrin, tylenol
prn
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Case Study:
Observation of feeding:
LC encouraged mother to try laid back positioning for the left breast (as baby has not been at
the left breast for the past day due to nipple pain with feeds). Mother reclined in chair and LC
placed rolled up burp cloth under maternal breast for support. Baby latched easily and
eagerly at the L breast.
Mother denied any pain with initial latch or during the feeding. Baby fed actively for about 10
minutes,with numerous sucks and swallows. Fed on R breast in same hold, numerous sucks
and swallows. Slight pain reported at beginning of feed on R side, pain decreased quickly as
feed progressed.
2015 Office Practicum User Conference
Let’s
Try It!
2015 Office Practicum User Conference
Questions ?
2015 Office Practicum User Conference
We want your feedback!
Reports to download:
Breastfeeding Template
Phrase Construction Notebook
2015 Office Practicum User Conference