According to the American Academy of Pediatrics (2005), exclusive breastfeeding is optimal nutrition and protection for infants for the first six months of life.  Breastfeeding has considerable benefits for mothers, infants and society (Center for Disease Control and Prevention, 2008).  AWHONN, Healthy People 2010, and the WHO acknowledge that increasing the proportion of mothers who breastfeed their babies is vital to the health promotion of our society.  Miller, et. al (2007) recognize the importance of provide evidence-based education and research to all maternal-infant nursing staff and providers.  Education of the direct patient care provider is vital in ensuring that evidence-based breastfeeding education and support is provided to our childbearing families.  Nurses have the power to exert an enormous positive effect for health benefits on society as a whole by focusing on increasing breastfeeding initiation when providing care to new mothers and infants (Miller, L.C., et al., 2007). 

At Naval Medical Center San Diego (NMCSD), we have 3 full-time lactation consultants (LCs) supporting approximately 300 deliveries per month.  In addition, the LCs provide coverage for patients in 5 inpatient units (PEDs, NICU, two post-partum units, and L&D) and provide services to patients referred through outpatient services.   For this reason, the majority of initial and continuing breastfeeding support is given by the bedside nursing staff. 

From November 2007-January 2008, we analyzed data from lactation consultant referral forms at NMCSD and focused on both to reasons for referral and interventions taken by the nursing staff.  The data reflected a large number of referrals for common breastfeeding problems despite breastfeeding education, referral to our in-house breastfeeding class, and positioning assistance.  The majority of the referrals reflected that the nursing staff did not intervene with basic problems solving prior to initiating the referral. 

Our review was limited by the use of the lactation referral sheet as a data collection tool.  The tool provides a checklist with indications that we found needed to be clarified to allow for more efficient triage of the patient.  ie. flat nipples, large nipples and inverted nipples were grouped together under one option.  It was also difficult to understand, from the referral sheets, which interventions were initiated prior to the request for lactation consultation.  If the nurse checked a box that the patient was referred to the breastfeeding class, there was no indication of whether or not the patient actually attended the class.  Limitations in the computerized infant assessment form also made it difficult to tell what kind of lactation support nursing staff provided.

Following our review of data and in examining our resources we knew we needed to plan interventions to improve breastfeeding assistance by bedside nurse.  Our poster will provide a look at those interventions to include revision of the referral tool and infant assessment form and providing an evidence based resource nursing guide in assisting breastfeeding families.  We hope to provide nursing staff with a resource to empower better lactation support and improve the accuracy of education provided to patients regarding lactation.  We plan to reevaluate the volume of consults and indications for an LC for three months following this intervention with the revised referral tool and revised infant assessment.  In addition, we plan to initiate a needs assessment to identify areas where additional education may be needed.