Mother's word is law

The nurses in the Women's Health Division seek to satisfy not only the newborns' appetites but also the parents' desires for when and what to feed their infants. To improve communication between parents and nurses, the Nursing Leadership Team developed the Infant Feeding Plan.

"With this new tool, the baby's nurse talks directly to the mom or parent to avoid misunderstandings," said Jennifer Peterman, RN, BSN, IBCLC, a certified lactation consultant in the Women's Health Division.

The Infant Feeding Plan began as an informed consent document. It has evolved into a communication tool initiated as part of the mother's electronic medical record. It indicates whether the parents want the infant to be breast-fed, formula fed or a combination of the two.

"Asking about a mother's preferred method of feeding for her new baby has always been a question labor and delivery nurses have asked their patients," said Ryan Olivere, RNC-OB, MSN, a clinical nurse specialist in the Labor & Delivery/Perinatal Evaluation Center. "This program has helped to streamline the process and has brought a patient-centered focus into the care we provide. The patient is now more active in the care she and her baby receive."

A paper copy of the infant feeding plan remains at the crib side, which means any nurse who cares for the baby in the nursery or intensive care nursery has easy access to the parents' wishes, Peterman said. If the parents change their minds about feeding method, feeding schedule or use of a pacifier, the document is updated and signed by the baby's nurse and a parent.

"The most compelling evidence [of the program[']s success] was actually observing mom, nurse and pediatrician reviewing and adapting the infant feeding plan at the crib side," said Marilyn Stringer, WHNP-BC, PhD, RDMS, FAAN, a clinician educator and professor of women's health nursing.

While the main goal of the feeding plan is to ensure nurses understand the wishes of their young patients' parents, the improvement in communication has yielded another positive outcome — breast-feeding rates have risen. "[In] the fiscal year preceding this initiative, the hospital breast-feeding initiation rate was 68%," Peterman wrote in an abstract submitted to the Association of Women's Health, Obstetric and Neonatal Nurses. "The fiscal year that started a few months after this plan was introduced had a breast-feeding initiation rate of 74%."

The program won the praise of The Joint Commission, which named it a Best Practice Model of Care. "JCAHO loved it when they came in," Peterman said. "They really thought it was good care."