2015 User Conference

Lactation ConsultingApril 24 & 25, 2015

Presented by:

Beverly Curtis, DNP, PPCNP-BC, IBCLCBJ 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.

2015 Office Practicum User Conference

Poll… Is your system ready for today?

Have you Uploaded? Have you Created?

❏ the modified Breastfeeding Templates

❏ Yes

❏ No

❏ the baby patient to chart on

❏ Yes

❏ No

❏ the Phrase Construction Notebook

❏ Yes

❏ No

❏ the mother patient to chart on

❏ Yes

❏ 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 templates1. 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 EXIT2.Choose Save

Practice Policy Question: are your templates set so only Providers can choose to “Save and Finalize”

2015 Office Practicum User Conference

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 inchesInfant HC: 38 cmInfant is not currently taking any medication

Maternal vitals:Maternal BP 115/72Pulse 75Temp: 98.7

Maternal medications:Chronic: armour for thyroidDuring pregnancy: prenatal vitaminsPresent: prenatal vitamins, armour for thyroid, dicloxacillin 500 mg, qid, motrin, tylenol prn

2015 Office Practicum User Conference

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