rooming in - are you really??...rooming in some stuff out there about “23/24 hours” this is not...
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Rooming in -Are you really??
Anne Merewood PhD MPH IBCLCConsultant to the Indian Health
Service
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Step 7Practice "rooming in“ – allow mothers and infants to remain together 24 hours a day. Yes that really does say, 24 hoursAny exceptions?
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Rooming inSome stuff out there about “23/24 hours”This is not very helpfulA baby could be out 2 hours for a serious medical issue/procedure – this is OKA baby could be out 15 mins for a hearing screen; this is not OK
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Rooming inWhen is it ok not to?
If a baby has to have a procedure
Circumcision Spinal etc.
Mom requests it, is educatedA safety issue (mom real sick, noone else there, etc)
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Rooming in – when should they stay in?
Hearing screenPediatric examsRoutine blood draws/heel sticksBathNight-time
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Strange goings on…..
Shouldn’t no nursery mean automatic rooming in?Shouldn’t LDRPs mean rooming in?Low volume/rooming not really related either……
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Is mom the problem?
“She wants rest at night”“She doesn’t want to see tests/ heelsticks”“She wants to send baby to nursery”
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Moms and rooming in
Who is really asking about the nursery?Sometimes momSometimes, the staff….
If it’s momEducateDocument education in the medical record
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Moms and rooming in
If 1 mom does this…fineIf ALL moms do it, hmmmmSometimes can be cultural
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Clinicians and rooming in
May really believe mom will sleep betterEvidence does not support this
Comfort level doing tests in room?Comfort level talking to patients?Practical issues
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Practical help
Portable scale on cartMoveable lightsOtoscopesBaths on wheels
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Why are some clinicians not on board?
A real life example……Pediatricians REFUSING to examine newborns in moms’ roomsMain rationale: “It’s too dark”…adding “if we had portable lights, and we left them in a room, a child might play with them, knock them over, and get hurt”
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And……
Hospital had 2-3 births/weekAt our visit, 1 baby postpartumTime saving not an issue
Took longer to get baby to nursery and back, than to do exam in mom’s room
Other providers hurtling ahead – whole unit gung ho about skin to skin post cesarean
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SO….
I asked pediatrician #3“How do lights on postpartum compare with lights in this room?” [pediatric outpatient unit]
“Let’s walk over and take a look”“Maybe you can use brighter bulbs while you wait for portable lights”
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Fact finding missionLighting on postpartum same as outpatient pediHospital HAD beautiful lightsLighting NOT the problemYOU knew that, right?So what was?
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The real problem
Dr X“It takes time to change” (true, but OB colleagues doing c-sec skin to skin on everyone)“IT’S ONLY A 10 MINUTE EXAM. HOW CAN THAT MATTER?”Ahaaaa…now we’re talking.Explain why in the context, it matters
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Why 10 minutes matters
We are talking a culture changeIf a dr does exams in the nursery
A nurse might then do bath in nurseryA tech might do hearing screen in nurserySomeone will do newborn heelstick/screen in nursery…..etc
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Documentation
Rooming in: the “norm”Each time baby leaves room: Document!When baby comes back: Document!If baby goes for a non medical reason, Document - maternal education AND times in and out
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Man, that’s a lot of documentation….
…….maybe it would just be easier if we left them in the room, then we would have no need to document………..
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Documentation
For example10am – baby left room for hearing screen10:15 – baby came back
Note – this is NOT acceptable REASON, but at least the documentation is right!
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Documentation
For exampleMother requested baby go to nursery for the nightMother was educated on benefits of rooming in and exclusive breastfeedingMother insisted she needed 4 hours of sleep with no baby in the room
This is ok as long as it’s documented and backed up by maternal report
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System changes to help
Rename nursery the Neonatal Observation UnitTurn off lightsInvite mothers inCreate a “NOW”: nursery on wheels The best nursery is
an empty nursery
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Stages of changeEquilibrium – we’re here, and we’re happyDenial – those breastfeeding people aren’t really thereAnger – darn it they are there and they’re not going awayBargaining – how about we only keep babies in the nursery for 3 hours instead of 4?
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Stages of changeChaos – what the heck is going on?Depression – we’re done forResignation – what are we supposed to do?Openness – I wasn’t really listening, can you say it again?Readiness – I guess I can tryRe emergence – Hmm. Kind of cool. I might even be a better…..