Assessment and Documentation of Feedings

Assessment and Documentation of Feedings Birth & Beyond California: Breastfeeding Training & QI Project

Objectives • Identify two signs of comfortable positioning • List three signs of an effective latch • Identify two latch problems in need of referral to a lactation consultant

Signs of Comfortable Positioning • Mother in physiological alignment • Back straight, joints flexed, no straining • Posture supported with pillows, foot rest • Infant facing mother • Head, chest, hips in straight line • Ventral flexion • Trunk and head supported

Evaluate Positioning

Signs of Effective Latch • Wide angled mouth opening • Chin deep into breast – head tilted back • Much of areola taken into mouth • Lips flanged back by breast • Tongue visible under areola

Signs of Effective Latch • Gliding jaw movements • Rhythmic sucking bursts with swallows • Mother comfortable – baby relaxed

Evaluate Latch

Nipple Appearance After Feeding Undistorted Nipple Pinched nipple

Breastfeeding Assessment Tools • A psychometrically sound neonate feeding assessment tool has not yet been empirically validated • Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions • Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care • Howe, Lin et al. JOGNN, 2008.

LATCH Reporting

Helping a New Mother to Breastfeed Royal College of Midwives

ACTIVITY • Breastfeeding Assessment Documentation

Mother Reported Assessments • Several feedings should be directly observed by a nurse in each 24 hours • Mother self reported assessments may be used between nurse observations

Latch Problems in Need of Referral • Refusal to latch after 24 hours • Poor/inconsistent latch after 24 hours • No audible swallowing • Inverted nipples • Unresolved pain, >3 in the 10-point pain scale

Plan of Care: Ineffective Breastfeeding • Refer to lactation consultant • Feed the baby • Supplement appropriately • Protect mother's milk supply • Mechanical & hand expression

Summary • Feedings need to be observed by a nurse on each shift • Assessments need to be shared with the mother and documented on patient chart and progress notes • Maternal self reported assessments may be used between nurse observations • Couplets will be referred to a more experienced lactation professional as needed

Photo Credits • Slide 1 – Winter Nursing by J. Kirk Richards

Assessment and Documentation of Feedings

Assessment and Documentation of Feedings

Presentation Transcript

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Physical Assessment Documentation Change Tutorial

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Documentation for Health Assessment

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Internal documentation and user documentation

Inpatient small feedings

Examination and Documentation of GBV

Documentation and Maintenance of Records

INTRODUCTION OF THE STANDARDISED INITIAL ASSESSMENT, CARE PLANNING AND REFERRAL DOCUMENTATION

Sources and documentation

Small Feedings of the Mind: Rheumatology

ENTERAL AND PARENTERAL FEEDINGS

Developing a Spiritual Plan of Care Session 01: Assessment and Documentation

Multiple Feedings of the Mind- Palliative Care Pearls

Internal documentation and user documentation

Definition and overview of required safety documentation (e.g., safety case and safety assessment)