nursing assistants mixing breastmilk

elizabells, BSN, RN · Mar 6, 2009

Man, we don't even let moms put their own breast milk in the fridge anymore. Like Steve said, triple scan with the barcode dealie. When a junior nurse screwed up EBM, they got suspended. Once it happened to a senior nurse, oh, hey, it's a SYSTEMS error, let's make a new policy. Siiiigh.

dawnebeth · Mar 6, 2009

We went through multiple versions of checking breast milk, from different colored labels, to big ones, small ones, but mainly, double checking the medical number with another nurse is what has worked best. We don't scan the bar codes because we have the bar codes, but not a scanner. lol

We no longer allow the parents to put it in the freezer or take breast milk out of the fridge because one parent accidentally gave his baby the wrong milk once. In the past, that happened occasionally with nurses (happened to me one time), however, no one was ever suspended. We do try to tweak how we are checking the milk and mixing it every few months to see what has worked best. Definitely the double checking of the medical number and double signing on the nurses notes.

Dawn

Cambria1023 · Mar 10, 2009

We don't have a HUGE unit (on average, around 25 babies) with all private rooms. Each room has their own fridge/freezer in which parents place their labeled BM. When it comes time to feed, the RN is responsible for double-checking with another person (parent, nurse, etc) and will mix up the feeding on her own. Pretty simple.

twinkletoes53 · Mar 12, 2009

Wow. An entire job just for doing EBM? Do you have your own EBM bank or something?

I work in an 85 bed Level III NICU. We have a full time Lactation Consultant to educate, assist, and support our mothers, plus trained lactation technicians that draw up and add additives, if ordered, to all our EBM. We may have as many as 40 babies receiving EBM for feedings, each with different additives. (e.g. add HMF; mix 1:1 with PEF; add EnfaCare powder to equal __cal/oz, etc). Staff RNs used to draw up and mix each baby's breast milk, but with our NICU growing so fast, we now have full-time employees hired specifically to do this. Each feeding is co-signed by 2 staff members prior to being administered. It can be an RN and a PCA (patient care assistant) that verify the milk.

The milk is prepared in a separate "Lactation Room" for quality control purposes. We have 2 large freezers for our milk. Each mom who is pumping has her own "bin' in a refridgerator located ouside the lactation room. Their bin has a padlock on it, and they are given their baby's combination number. Staff RN have a master key to access each bin for EBM as needed. Our NICU has a pumping room with 4 rocking chairs in it for our mothers to pump. it has a TV in it, and is fully stocked with supplies they need for pumping, storing, and labeling their baby's EBM. We also have a pump set-up in the R.McDonald House, where a lot of our families stay.

Florida NICU RN · Apr 21, 2009

In our unit, RNs mix the EBM with HFM (if ordered). Our techs feed their assigned babies and an RN or parent double-checks that it's the correct breastmilk for that baby. It's then initialled on the Treatment MAR that it was checked but the tech can't do that (only an RN).

And wow. A "milk tech"??? That's got to be a LOT of EBM.

nicu4me · Apr 21, 2009

FLorida NICU ---- your tech's feed your babies??

Florida NICU RN · Apr 21, 2009

Yes, they sure do but only feeder/growers. They're usually assigned two-three babies and are responsible for vitals, changing their diaper, and feeding (q3).

nicu4me · Apr 21, 2009

We do not have any techs. We have a 40 bed Level 3. Curious, even on our feeder growers, we still have to assess them. How are you fitting in your assessments around their feeding times? Are the techs only nippling them or gavage? Also, would they still be considered level 2 babies then or would it be more like a level one? So if you don't mind me asking, what would your patient load be like then if you are also responsible for the pts the techs take? We usually have 2-3 pts. 1 HFOV w/ 1 nippler, or 1 BCPAP w/ 1 vent. Usually not two HFOV or two vents or two BCPAP together. Or it could be a threesome of 1 bubble or vent with 2 nipplers. It just depends. I know of some nicus where they only have 1:1 hfov. Not ours, just wondering how you utilized your techs, you should see our unit clerk look at the babies, she just wishes she could touch one of them! Thanks!

Florida NICU RN · Apr 21, 2009

We still have to assess our babies (full assessment is normally q 6hrs, sometimes more frequently). Some of us prefer to not have a tech because of assessments and it's just easier to get everything done at once. Otherwise, some assess and leave the feeding for the tech. Just depends. They can't gavage. Just bottle feed. They're "level 2" babies and the RN will normally have 3 of them. Occasionally, there may be one of those mixed with 1-2 level 3's (vent, etc.). The techs also clean the incubators and cribs during the times they're not feeding a baby. Our techs are all CNA-level and trained to work with us.

littleneoRN · Apr 22, 2009

So if you have three level 2 babies with a tech, and the tech does diapers, vitals, feedings, linen changes, and you do assessments and gavage feeds...what does the RN do during the shift? And do these aides bottle kids who have tendencies for significant choking or apnea with feedings? Just curious.

chescat58, RNC-NIC · Apr 29, 2009

Wow. An entire job just for doing EBM? Do you have your own EBM bank or something?

No milk bank - just a 112 bed unit.

MandaAnda · Apr 29, 2009

No milk bank, just a 112 bed unit that runs anywhere from 95 - 138. We have 2 milk techs on every day just for EBM. And it usually takes them all day to do the unit.

Um, you said that already in reply to my query, back in February. See ^^.