Maybe you’ve read my post about red flags for hospital discharge. And you’re thinking, “Okay, so how can I eliminate or at least minimize those factors?” Here how to start your discharge planning strategies.
1. Begin discharge planning strategies early
This is like … Nursing 101, right? We all learned that discharge planning begins at the time of admission.
Yet, it’s often unrealistic.
First there’s hospital admission. Then, there might be admission to several different units, depending on the structure of the birth facility and individual needs: labor/delivery, postpartum, mother-baby unit, nursery, neonatal intensive care unit, or special care unit.
When you’re talking about an adult patient and a newborn who have likely been admitted to multiple different units (or sometimes to different services or even different hospitals!) it gets hairy.
Hence, the moral of the story is simple. As soon as you have the whole or at least most of the clinical picture, start your discharge planning strategies.
In my hospital days, few things would make me crazier than this scenario: “Marie, would you come over to the NICU and help Ms. X with breastfeeding?”
And when I arrived, I would find Ms. X fully clothed, sitting in the wheelchair with her baby wrapped up like a burrito, and warning me that the family had the car parked in the “no parking” zone.
I think you get my point. Start planning early.
2. Perform weight checks
For several reasons, weight checks may not be the be-all and end-all. Being weighed on more than one scale, or at different times of day, or with user-error, is far from ideal, as you heard in my podcast with Dr. Jenny Thomas.
But babies need to be weighed.
Some babies need to be weighed frequently. Especially those who are premature or compromised. This is generally referred to as pre-feeding (AC) and post-feeding (PC) weights, or sometimes just “test-weights.”
3. Observe stool patterns
For newborns, stools are more important than voids. Period.
As Dr. Jenny Thomas explained, stools in the newborn represent amniotic fluid, milk, and oligosaccharides.
In theory, urine output should be the water from the milk the babies are getting, right? Maybe.
Some babies have copious urine output because their mothers have had a lot of IV fluid during labor. So that’s not always a good indicator of whether they are getting enough nutrition.
Further, there’s a massive misconception about how much time can elapse before a newborn “goes.” That’s because both parents and providers equate a newborn’s stool habits with those of older breastfed babies.
Hear me, loud and clear.
These are rough numbers, but easy to remember for a normal healthy newborn born at term:
- During the first 24 hours, I want to see at least ONE meconium stool.
- On day 2, I want to see at least 2 stools.
- On day 3, I want to see at least 3 stools.
Thereafter, during the first month of life, most authorities agree that a breastfed infant should have at least 3 stools per day. Pediatric gastroenterologist Dr. Bryan Vartabedian, author of Looking Out for Number Two, says he wants to see at least 4 stools per day during that period.
After the first month of life, it’s not unusual for infants to have multiple days between stools.
When implementing your discharge planning strategies, make these observations, and do some parent teaching for the future, too.
4. Remember that pathology can and does go undetected
We’d like to think that all babies are healthy. And most of them are.
Some of them aren’t.
I’ve lived long enough to realize that pathology can be overlooked. Infants can and sometimes do have pathology that goes undiagnosed for hours, days, weeks, or even months.
I distinctly remember a 6-day old who had been born in a community hospital and was later admitted to our regional medical center for a respiratory problem. I insisted that the baby had a cleft palate. But since I was “just a nurse,” I had a tough time getting the physicians to listen. Finally, one did. Sure enough, she diagnosed it.
Similarly, I remember a baby who was about 5 weeks old. The baby had seen the pediatrician several times. Over a period of several hours, I saw classic signs of pyloric stenosis.
Here’s another one. From teammates, I’ve often heard, “Oh, Marie, she couldn’t have yeast on her nipples! She’s only 2 days postpartum!”
Well, yeah, she could. Candida can’t read a calendar.
Believe me, there are dozens of examples where pathology has been overlooked in either the infant or the mother.
Again, this isn’t everything you’ll ever need to know, but I’m hopeful that these discharge planning strategies will help you to get started at heading off problems before they occur.
Have you used these discharge planning strategies to prevent issues down the road? Share your experiences in the comments below!