In both the Nursery and NICU we have been hard at work developing methods to enhance Skin to Skin care time for babies and parents. Some great ideas have emerged for incorporating Close To Me into NICU care. Additionally we have a Nursery Working Group engaged in adapting the Close To Me program to the mother-baby unit. While all this great work is ongoing don't forget to be reviewing your data. You will no doubt identify opportunities to excel in additional areas when as you study your unit's progress to date. We will discuss data and these opportunities in more detail at webinars this month.

As Miriam Labbok reminds us, we have a number of other critical components in both action plans that deserve our attention. As you review your data from the NICU and Mother-Baby Units consider these elements and where there are targets worthy of focus:      

NCCC

1. Are we assessing feeding intention on admission and informing mothers that breast milk is best medicine?
2. Are we offering early support to mothers including instructing in use and supplying a pump, breast massage technique, and the use of pumping logs?
3. We have been hard at work on skin to skin but are we promoting non-nutritive sucking during this time and pumping immediately following skin to skin contact?
4. Have we begun to develop or initiated standardized guidelines for beginning and advancing feedings?
5. Have we addressed staff lactation education and support needs in the nursery?

Mother- Baby

1. Are we asking if mothers they are going to breastfeed?
2. Are we routinely informing mothers about lactation support services that are available?
3. We are actively working on skin to skin but are we also assessing infant's readiness to feed and educating mothers regarding cues in the first 90 minutes after birth?
4. Have we developed charting that supports regular assessment by staff of mother's comfort during breastfeeding?
5. Have we taken steps to limit the ready availability of infant formula?
6. Have we developed practices that support infants, mothers and families staying together?
7. Have we fully oriented all staff to hand expression techniques and are we encouraging education of mothers as part of routine mother-baby care?