Good evidence based practice websites

[babynurse357]

Does anybody have any good evidence based websites. There are several issues in the facility where I now work that need to be addressed. I'd like to have studies to back me up before I go to the DON requesting changes. A few of the issues are:

1.we check blood sugars on EVERY baby after delivery even if asymptomatic and not LGA/SGA/or infant of a diabetic mother,etc

2.if the sugar IS low we give empty calorie glucose water instead of formula

3.all bottle-fed babies get glucose water for the first feeding instead of formula, I have no idea why

4.there is most generally only 1 nurse and the doctor present for delivery-I think we always need a 2nd set of hands. What if mom AND baby crash?

5.we don't do couplet care, which is frustrating for pts at night to have a nursery nurse AND another nurse in and out of the room

Any input on these issues would be appreciated.

Thx!

[SmilingBluEyes]

How about checking out World Health /Organization (WHO)/UNICEF Standards, particularly as they apply to baby-friendly hospitals?

There IS no evidence supporting any of the above practices, and as a matter of fact, these can be more harmful than anything else. (especially feeding anything but breastmilk unless absolutely medically-indicated).

Also do you have any Lactation Consultants on staff? If so, get them on board to help change things!!!!!

Check this out:

http://www.usbreastfeeding.org/breastfeeding/compend-babyfriendlywho.htm

From this site, specifically, 10 steps to successful breastfeeding:

1. Have a written breastfeeding policy that is regularly communicated to all health care staff;

2. Train all staff in skills necessary to implement this policy;

3. Inform all pregnant women about the benefits and management of breastfeeding;

4. Help mothers initiate breastfeeding within half an hour of birth;

5. Show mothers how to breastfeed and how to sustain lactation, even if they should be separated from their infants;

6. Feed newborn infants nothing but breastmilk, unless medically indicated, and under no circumstances provide breastmilk substitutes, feeding bottles, or pacifiers free of charge or at low cost;

7. Practice rooming-in which allows mothers and infants to remain together 24 hours a day;

8. Encourage breastfeeding on demand;

9. Give no artificial pacifiers to breastfeeding infants;

10. Help start breastfeeding support groups and refer mothers to them.

[SmilingBluEyes]

PS: If you do not have a nurse present at every birth who is dedicated to the newborn, you are violating a standard of care outlined by NRP (Neonatal Resuscitation Program) standards.

See:

http://www.aap.org/nrp/nrpmain.html

Or consult your NRP manual in your hospital library. It says this in there.

While this is not a governing agency, this is the standard of care for hospitals where babies are born. Being NRP-certified holds each of us to this standard. You therefore, need to have two nurses at each birth; one for circulating the birth and one who is dedicated to helping the newborn transition immediately after birth. The newborn nurse need not be there long---just long enough to determine the baby is stable, not in need of special care or resuscitation. No one can predict exactly which newborns might need resuscitation ---as we all well know. We have to be prepared. You asked it yourself: "what if mom AND baby crash?" That is why the standard of care exists as it does. Also consider, newborn resuscitation is not a one-person job. It takes no less than 2 people to fully do this--sometimes more if the baby is really doing poorly. You can't get a good handle on this if there is only one nurse in the room to start with, believe me.

I hope you can be an agent of change where you are. My hat is off to you for thinking about these things and wanting to see them change. GOOD WORK!

[babyktchr, BSN, RN]

We used to do the glucose water for the first feeding, but stopped some time ago. The rationale was to check patentcy of the esphogus, that if the baby aspirated it would be a clear liquid and not formula. We also held feedings on a bottle feeding baby for 4 hours (breastfed babies went right to breast). We no longer do that either...as to why, don't know. It just became law somehow.

Why do you do sugar's on all of the babies? What is the rationale behind that policy?

You MUST MUST MUST have 2 NRP certified people in a delivery. As SBE says above, it is standard of care. You will have not a leg to stand on if you have a bad outcome and don't have what you require in the delivery. That is negligence. NRP guidelines (AAP website) has the standards for that....and every well managed unit should know this.

As SBE said....KUDOS to you for taking this on.

[MikeyJ, RN]

http://www.guideline.gov

Those are the national guidelines for evidence-based practice.

[babynurse357]

Thanks for the input. The previous place where I worked for like 5 years did have 2 nurses present for delivery, so I'm aware of how things should be done (that's why I'm on this mission). What I think is the problem is that we only delivery about 400 babies per year and most of the nurses who work here have only ever worked here and maybe don't see how unsafe it is to only have 1 nurse in delivery. Also, our DON has no OB experience so she doesn't really get it either. Lucky for me I have a coworker who is also new here with previous experience elsewhere who is in my boat. Together hopefully we will overcome our issues.

One nurse argued with me one day that we can't have 2 nurses in delivery at night because there are usually just 2 of us here and "these people pay $500 per day for the nursery, so if they want their babies in the nursery we have to keep them!" This is total BS in my opinion. The safety and wellbeing of a delivering mom and babe is WAY MORE IMPORTANT than a healthy baby in the nursery who could go out to mom's room for 1/2 hour or so...

I'm just trying to get my ducks in a row before I bring anything up with the DON.

[country mom]

Good for you, babynurse! The world is a better place when nurses like yourself are looking out for their patients!

[FLOBRN]

Not a website, but if you join the perinatal nursing list out of U Buff (just "google" perinatal nursing list) the members are glad to share any and all information they have. There is also a policy and procedure file and a power point presentation file on yahoo groups that people post stuff to for anyone to use.