That which remains unexamined, continues.
To ensure you’re not perpetuating unsafe, unfounded, or outdated practices – try this :
Imagine doing a retrospective chart audit about oral feeding practice from the baby’s perspective – a baby born at 24 weeks GA. His name is Emmett.
Initiative: Compliance with oral feeding practices
Chart Audit Questions from Emmett’s perspective:
- When was I first held by my mom and/or dad?
- When did I first get food in my stomach?
- Did my parents get to tuck their hands around me while I was fed, or get to hold me?
- If they weren’t there, did my nurses or therapists do that instead with each of my feedings, so I understood that feeding was a nurturing interaction?
- Was I always positioned well so that when I started to breastfeed my body was not tight anywhere and my head and neck were in alignment for easier sucking, swallowing and breathing?
- Was I protected from loud noises so I could sleep and grow to the best of my ability?
- Was I given my mom’s milk or human milk – at least at first?
- Did I get to be close to my mom’s skin every day, or most days? What about my dad?
- Did I get to hold hands with my big sister?
- Was I awakened from sleep slowly and intentionally or abruptly turned over and startled?
- I tried to tell people that I liked someone to keep me calm while uncomfortable things were happening. Did they listen? Did they tell the next people?
- Did anyone notice how high those SATs were when my dad read to me?
- My favorite nurse kept her hand on my head for an extra-long time after suctioning and always made my pain way less than it could have been. She also called me Emmett and knew exactly how I liked to be snuggled in for a nap. She even made sure my diapers were not too bulky for my tiny-sized hips. She always took time to help me get situated with my mom just in time for the food to go into my stomach. Did someone tell her she did a great job?
- Did my caregivers give me a pacifier to help me soothe myself? What about during my tube feedings, so I could practice sucking while being fed?
- Did my caregivers assess how I was progressing and preparing to eat by mouth? How did they choose to do that? How did everyone else know what they saw?
- When did I start ‘practicing’ breastfeeding?
- Now that I’m getting older and out of that box, did they notice that how I’m starting to wiggle my hands closer to my face, especially when I’m hungry?
- Did they write that down so other people will know?
- Did they notice that I can stay awake much longer now?
- Did they begin scoring my feeding readiness so that the whole team knew when I was ready to give this feeding thing a real try?
- Was my first feeding a breastfeeding?
- If not, did my mom or dad still get to feed me or be present that first time? (We waited so long to do that together!)
- Did my caregivers promise not to change the nipple 100 times? I have no idea what to expect when they do that. I thrive on educated choices and consistency.
- No matter how I ate, did I get a score for feeding quality so everyone knew how my eating skills were developing?
- Did they write down what they did that helped me so the next person could do it too?
- Did everyone on my team use the same language so no one was confused?
- Did the team listen to what I was saying during my feedings?
- Did they understand that I was scared when I choked or couldn’t breathe for those really long seconds?
- Did they understand that when all those buzzers were going off, I was really struggling?
- Did they pay really close attention so that mostly the buzzers didn’t go off?
- Did they understand that some ways they fed me really helped me, and others made me more likely to swallow it down the wrong hatch?
- Did they teach my mom and dad everything they know about feeding babies like me?
- Could they tell when I was too tired to drink and was likely to choke, cough, sputter if they kept going?
- Could they read my cues? Did they follow them?
- Did they work extra hard to make sure my mom and dad fed me over and over so they became the experts in feeding me?
- Did they know exactly when to all meet together to discuss finally pulling that tube out of my nose?
- Did they keep writing down my readiness and quality scores even when my tube was gone so everyone would know if I was really ready to go home?
- Did they figure out how I could still breastfeed most of the time, even though I had to have a few bottles of that high protein stuff each day?
- In those last days, did they stop freaking out about whether I took 44mls or 47mls and just feed me like I was at home and watched my weight?
- Did everyone make sure I was ENJOYING my time eating instead of dreading it or surviving it?
- Did anyone mind when I threw up on my new outfit that one time? (I thought it was kinda funny.)
- Did my caregivers and parents work as a team all for ME?
- Was anyone scheduled to check up on me after I went home to make sure all that feeding stuff was still going well? What about when I was 4 months old? (I heard that’s a tricky time!) What about when I was 1 year old?
- Do you think my caregivers know how much I appreciate them?
As it turns out, Emmett is quite the thorough reviewer! And he could’ve gone deeper or broader, but you get the picture.
But what if he really did have a voice?
He does of course.
You are his voice. His parents are his voice.
His body speaks. You listen and respond.
If babies were in charge of your chart audits, how would your unit measure up?