Marie's Outlook

10 “Must Do” Steps Before Your Baby-Friendly Survey

Undertaking the process of being designated as a Baby-Friendly facility can cause a case of nerves at the best of times. But in the case of any number of common last-minute issues, it can make you feel downright queasy, wondering how you and everyone else at the hospital will “prove” your worthiness to achieve the Baby-Friendly designation.

Here are 10 steps to help ensure you’re as ready as possible when the assessors arrives on your doorstep.

1. Get your paperwork in order.
Whether it’s real paper, or computerized records, be sure that any and all paperwork is in order. It’s doubtful that the assessors will ask for every scrap of paper you have ever generated during the survey, but they are free to ask for anything, so be prepared. This includes paperwork to support your hospital structure, such as policies and procedures, but it also includes the curriculum for prenatal classes, education materials, staff training logs, and more. I always urge hospitals to start a notebook making a list of their “paperwork” and its location early in their Baby-Friendly journey. That way, when the big day comes, it’s not too difficult to locate the needed items, and it makes sure that everyone else can, too.

2. Quiz your director.
Yes, that’s right. Someone—maybe you, maybe someone else—needs to conduct a dry run quiz of the director. It’s not necessary for the director to know every detail of an individual’s care, but it’s critical that he or she know the main tenets of the “Ten Steps” and how those steps are implemented in the hospital. Often, directors defer to a designated staff person, such as the lactation consultant; that may be okay, as long as the Director can answer most of the questions herself. As I like to remind people, there’s a reason why we call them “directors.” It’s because they “direct” the care that is give on the clinical units. If they aren’t “directing” the Ten Steps, it’s an indicator of lack of clarity, consistency, and commitment.

3. Quiz your staff.
All members of your staff need to know, backwards and forwards, the requirements of the Ten Steps. However, they are also expected to know situations where meeting the ideal is impossible or impractical, and they should be willing and able to explain what happens in a situation where the ideal did not occur. For example, there may be a justifiable reason why a baby did not room in during the night, but “mother was too tired” is not a justifiable reason.  Whatever you do, do not allow staff to defer to the lactation consultant for multiple questions. The Baby-Friendly initiative is about the practices of the entire team. If the lactation consultant has to answer everything, it shows that the staff is not up to snuff.

4. Quiz your patients.
This is critical. You’ll probably be surprised at how many patients will be interviewed—perhaps at length—by the Baby-Friendly assessors. It’s a good idea to see how they’ll do (and, therefore, how you did in teaching them!) Ask in-patients and recently-discharged patients to “teach back” the information they were given. If they are unable to do that, you might still have time to reinforce their knowledge.

5. Go on an UnTreasure Hunt.
Make sure that every trace of formula and bottle promotional material is gone. I mean, every trace. When I was an assessor, I did not hesitate to open even cabinet and every drawer, or to peek beneath every pile. You probably know that pens, pads, ornaments, and other clever items from formula companies are taboo, and you probably disposed of them earlier, but make sure that a rogue item didn’t creep in somewhere. And, make sure that old videotapes or other patient teaching materials aren’t anywhere to be found. Code compliance matters.

6. Appoint your point people.
Someone needs to function as a “greeter” and general guide for the survey team, and that person should be confident, upbeat, and experienced. The survey team does not need to be chaperoned, but they do depend on a hospital-based person to help them find their way around and to be introduced to the patients who have agreed to talk with them. The greeter should be courteous and hospitable, and she should point out a break room where assessors can sit to read information, or perhaps refresh themselves with a cup of coffee. All of this might seem like nothing more than good manners, but honestly, if it’s “someone’s” job, then it’s likely “no one’s” job, and some last-minute panic can ensue unless someone has been assigned to the task.  Similarly, determine in advance who will attend the closing conference, and make sure that those people know the time and location of the meeting. The closing conference is important.

7. Make sure everyone tells the same story.
“The same story” is the single most important thing I looked for in my assessor days. To find out how one of the Ten Steps is being implemented, I would ask the director what is supposed to happen. Then, I’d ask the staff what happened with a particular mother. Next, I’d talk with that mother. Finally, I’d look at the mother’s medical record. Sometimes, there are understandable discrepancies. For example, a mother who had a cesarean delivery with general anesthesia might not remember all of her facts correctly. But if the staff nurse tells me one thing, and the mother and the record say something else, my antenna quickly goes up.

8. Set ground rules for information-giving.
Hospital staff can become nervous at the thought of being questioned. The first ground rule is to tell the truth. Staff should not make up or “fudge” or guess at an answer. Instead, they should say, “I don’t know without looking it up.”  Alternatively, “I honestly don’t recall.” Staff should be instructed to provide ONLY the requested information or documents; no more and no less. Do not leave any other documents in plain sight; anything an assessor notices can be used against you.

9. Remember that every assessor is different.
If you’ve endured a survey from The Joint Commission, you know that every assessor is a bit different. The same is true for the Baby-Friendly assessors. Some are talkative and congenial; others are reserved and aloof. Some snoop for details that others would never think mention. If you a friend at another hospital who reports the demeanor of the assessors or what they did, just remember that the assessors who show up on your door might be very different.

10. Don’t delude yourself.
In my experience, most hospitals overestimate their compliance with the Ten Steps. Try to your facility’s health care as it really is, and make adjustments accordingly. Consider getting some expert guidance on your path to Baby-Friendly designation.

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