SARASOTA MEMORIAL HOSPITAL POLICY

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1 PS1070 SARASOTA MEMORIAL HOSPITAL POLICY TITLE: BREAST MILK EXPOSURE POLICY #: EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY TYPE: 5/23/06 06/15/18 Clinical Non-Clinical 1 of 11 Job Title of Responsible Owner: Director of Women and Children s Services PURPOSE: POLICY STATEMENT: To provide guidelines to health care workers in the event an infant/child is given the wrong breast milk. Sarasota Memorial Health Care System (SMHCS) provides a mechanism for reporting, medical evaluation and follow-up for exposure to the wrong breast milk. An occurrence report must be completed and physician notified. EXCEPTIONS: Due to the pasteurization and strict screening and testing of donor human milk purchased through the Human Milk Banking Association of North America, exposure of an infant to this donor human milk in error requires no medical follow up. DEFINITIONS: 1. Breast milk: synonymous with human milk or mother s milk or Expressed Breastmilk (EBM). 2. Recipient patient: patient who received the wrong mother s breast milk. 3. Recipient parent: parents of infant who received the wrong mother s breast milk. 4. Donor patient: patient whose mother s milk was inadvertently given to the wrong infant. 5. Donor mother: mother whose milk inadvertently was given to the wrong infant. 6. Communicator: Shift Charge Nurse PROCEDURE Potential treatment or intervention is time sensitive. Initiate this policy immediately after the exposure has occurred.

2 2 of 11 RESPONSIBILITY Responsibility of employee when wrong breast milk is given to infant/child 1. In the event that an infant/child received the wrong breast milk, the responsibility of the employee and communicator is to: a. Contact the clinical manager b. Contact the attending pediatrician, family practitioner, or neonatologist of the recipient infant/child c. Contact the attending obstetrician of the donor mother if she is still an admitted inpatient or d. Contact the attending pediatrician, family practitioner, or neonatologist of the donor infant/child. e. Contact the attending obstetrician of the recipient mother if she is still an admitted inpatient f. Draw ordered labs on recipient infant, recipient mother, and donor mother. Call Laboratory, ext to register in LIS. Never order in SCM. It will provide an account name; number and nomenclature specific for breast milk exposure lab use. This will assist in providing anonymity. g. Contact the director h. Contact the nursing supervisor i. Contact the risk manager on-call j. Contact the director of Laboratory or senior manager on-call The attending physicians of both the recipient infant/child and the donor mother will address parental concerns regarding the breast milk exposure while the recipient infant remains an inpatient at Sarasota Memorial Hospital. If the donor mother is not an admitted inpatient herself, then the attending physician of the donor infant/child will serve in this capacity. At the time of the recipient infant s discharge, the attending physician of the recipient infant/child will be responsible for referring this patient to the Pediatric Infectious Disease service at All Children s for outpatient follow-up. As soon as practical, promptly complete an Occurrence Report and submit to Risk Management. Responsibility of recipient infant/child patient s attending

3 3 of 11 physician 1. Communicates with the recipient parent(s). Documentation of the conversation with the recipient mother is to be placed in the recipient infant s electronic medical record and can be composed as in this example: Mother informed her baby received expressed breast milk from another mother. Discussed significance with her. a. Explain risk factors. b. Health history screen c. Notify that HIV test is planned for infant and mother. d. Order the following tests for the recipient patient AND his/her mother: 1) HIV 1 & 2 antibodies (if the recipient mother is HIV positive, HIV by PCR is ordered instead of HIV 1 &2 antibodies). 2) HTLV I & II antibodies 3) HBsAg 4) Hepatitis C antibody 5) RPR (Syphilis) 6) West Nile Virus Antibody Panel 7) CMV (infant/child only) The recipient mother will need to register with Outpatient Registration for labs to be drawn by SMH laboratory. Call Laboratory, ext to register in LIS. Never order in SCM. It will provide an account name; number and nomenclature specific for breast milk exposure lab use. This will assist in providing anonymity. e. Query recipient parent regarding suctioning gastric content of recipient patient. f. Prescribe post-exposure prophylaxis for recipient infant/child if positive risk factors are present or recipient parent chooses therapy. g. The donor infant/child or donor mother s names are not disclosed to the recipient parents and the recipient s parents names are not disclosed to the donor mother or donor parents. h. Results will be communicated by the Laboratory initially by phone and followed up with a hard copy to the: i. covering physician when the infant is still an in-

4 4 of 11 patient who will notify the recipient mother. ii. Pediatrician/Family Physician if the infant has been discharged who will notify the recipient mother. 2. Place a referral order at time of discharge for Pediatric Infectious Diseases for outpatient consultation. Include all of the following in the order: a All microbiology and immunology lab results are to be mailed, not faxed, b. All follow up lab work ordered by Infectious Disease physician must be done through SMH Special Procedures Lab (this is necessary so the patient does not get charged for follow up lab work). c. Infectious Disease physician/office must call to arrange lab appointment d. Billing of Infection Disease office visit must NOT be run through recipient s insurance. Send visit bill to SMH Risk Management. 3. Provide continuous communication and work in conjunction with Risk Management and director(s) to address concerns with the family. 4. Support and assist the patient and family as needed. Responsibility of donor mother s attending obstetrician OR when the donor mother is no longer an admitted inpatient, then the pediatrician, family practitioner, or neonatologist of the donor mother s infant/child. 1. Communicates with the donor mother. a. Explains risk factors b. Health history screen c. Notify donor mother that HIV test is planned d. Order the following tests for the donor mother.** 1) HIV 1 & 2 antibodies (if the recipient mother is HIV positive, HIV by PCR is ordered instead of HIV 1 &2 antibodies). 2) HTLV I & II 3) HBsAg 4) Hepatitis C antibody 5) RPR (Syphilis)

5 5 of 11 6) West Nile Virus Antibody Panel The donor mother will need to register with Outpatient Registration for labs to be drawn by SMH laboratory. Call Lab, ext to register in LIS. Never order in SCM. It will provide an account name; number and nomenclature specific for breast milk exposure lab use. This will assist in providing anonymity. e. The recipient infant/child and recipient parent names are not disclosed to the donor parents and the donor mother s name will not be disclosed to the recipient infant/child family. f Results of tests to donor mother will be communicated by the Laboratory initially by phone and followed up with a hard copy to the: i. covering physician, when the donor mother is still and in-patient, who will notify the donor mother. ii. Obstetrician, if the donor mother has been discharged, who will notify the donor mother. g. Support and assist the patient and family as needed. Responsibility of Director/Clinical Manager/Nursing Supervisor. 1. Assist in contacting Risk manager on-call, and the attending physician(s) 2. Director or Manager communicates incident to family. Communication with the family can be delegated to the charge nurse. 3. Contact Director of Laboratory Services ext. 6494, Preanalytical Manager, Laboratory Services (Outpatient Manager), ext and Special Chemistry Supervisor, ext Ensures the occurrence report is completed correctly. 5. Refer to Addendum A: Recommended Orders for Breast Milk Exposure Recipient Infant/Child Patient. 6. Refer to Addendum B: Recommended Orders for Breast Milk Exposure Donor Mother. 7. Refer to Addendum C: Recommended Orders for Breast

6 6 of 11 Milk Exposure Recipient s Mother. Responsibility of Laboratory Director: 1. Expedites lab results as stat lab orders. a. Results will be communicated by the Laboratory initially by phone and followed up with a hard copy to the: i. covering physician, when the infant is still an inpatient,who will notify the recipient mother. ii. Pediatrician/Family Physician, if the infant has been discharged, who will notify the recipient mother. iii. covering physician, when the donor mother is still an in-patient, who will notify the donor mother. iv. Obstetrician, if the donor mother has been discharged, who will notify the donor mother. 2. Assures that the LIS orders and the breast milk exposure labs are processed properly. 3. Ensures the anonymity of the recipient infant as well as the recipient and donor mothers during entire incident and all follow up testing. 4. Assists mothers without patient registration as needed REFERENCE(S): 00.RSK.60-Disclosure of Unanticipated Outcomes & Medical Errors to Patients and/or Their Legally Authorized Representative. American Academy of Pediatrics, Section on Breastfeeding [2012] Breastfeeding and the use of human milk. Pediatrics, Vol 129, No 3. American Association of Critical Care Nurses, AWHONN & NANN [2015]. Core Curriculum for Neonatal Intensive Care Nursing. Elsevier, Saunders, MO. Center for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity. What can happen if someone else s breast milk is given to another child? Retrieved 10/10/15 from Hale, Thomas, Medications and Mother s Milk, 14 th Edition,

7 7 of 11 Amarillo: Hale Publishing Human Milk Banking Association of North America (2011). Best Practices for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings, 3 rd ed. HMBABA, Inc. Lawrence, Ruth A. and Lawrence, Robert M., Breastfeeding, A Guide for the Medical Professions, 7 th Edition, Elsevier: Mosby, MO REVIEWED BY: AUTHOR(S): ATTACHMENT(S): Lyn Wakeman, Risk Management Clinician Sherry Wolabaugh, MT, MPH, CIC, Manager Infection Prevention & Control Laura Logan, Medical Technologist, Laboratory Services Katherine Wimbish, PharmD., Pediatric/NICU Clinical Pharmacist Jeannie Sleight, RN, CBC, Clinical Practice Specialist, MBU Susan Doyle, RNC, CLC, Clinical Coordinator, NICU Mary O Connor, MSN, RNC, IBCLC, Manager Childbirth Education & Lactation Services Heike Bucken, RNC-NCC, CLC, Clinical Coordinator NICU Addendum A: Recommended Orders for Breast Milk Exposure Recipient Infant/Child Patient. Addendum B: Recommended Orders for Breast Milk Exposure Donor Mother. Addendum C: Recommended Orders for Breast Milk Exposure Recipient Mother

8 8 of 11 SARASOTA MEMORIAL HEALTH CARE SYSTEM 1700 S. Tamiami Trail Sarasota, FL Addendum A: Recommended Orders for Breast Milk Exposure Recipient Patient Weight kg Allergies: Food Allergies: Check box for STAT medications l! Date Time RECOMMENDED ORDERS FOR BREAST MILK EXPOSURE Recipient Infant/Child Patient Labs: Rapid HIV if recipient mother is HIV negative OR HIV by Qualitative PCR if Recipient Mother is HIV positive Mnemonics R HIV HIV Q HTLV I & II antibody HbsAg (Hepatitis B Surface Antigen) Hepatitis C antibody Reflex to HCV PCR if (+) HCV Ab RPR (Syphilis) CMV West Nile Virus Antibody Panel ELISA (Test name in comment field) LAB HBSAG HCV RPR CMVG, CMVM WN Suction gastric contents of recipient infant? Yes No Please contact physician for post exposure prophylaxis and consult Pharmacy if needed. Addendum A: Recommended Orders for Breast Milk Exposure Recipient Infant/Child Patient

9 9 of 11 SARASOTA MEMORIAL HEALTH CARE SYSTEM 1700 S. Tamiami Trail Sarasota, FL Addendum B: Recommended Orders for Breast Milk Exposure Donor Mother Weight kg Allergies: Food Allergies: Check box for STAT medications l! Date Time RECOMMENDED ORDERS FOR BREAST MILK EXPOSURE Donor Mother Labs: Rapid HIV if recipient mother is HIV negative OR HIV by Qualitative PCR if Recipient Mother is HIV positive Mnemonics R HIV HIV Q HTLV I & II antibody HBsAg (Hepatitis B Surface Antigen) Hepatitis C antibody RPR (Syphilis) West Nile Virus Antibody Panel, ELISA LAB HBSAG HCV RPR WN Addendum B: Recommended Orders for Breast Milk Exposure Donor Mother

10 10 of 11 SARASOTA MEMORIAL HEALTH CARE SYSTEM 1700 S. Tamiami Trail Sarasota, FL Addendum C: Recommended Orders for Breast Milk Exposure Recipient Mother Weight kg Allergies: Food Allergies: Check box for STAT medications l! Date Time RECOMMENDED ORDERS FOR BREAST MILK EXPOSURE Recipient s Mother Labs: Rapid HIV if recipient mother is HIV negative OR HIV by Qualitative PCR if Recipient Mother is HIV positive Mnemonics R HIV HIV Q HTLV I & II antibody HbsAg (Hepatitis B Surface Antigen) Hepatitis C antibody RPR (Syphilis) West Nile Virus Antibody Panel, ELISA LAB HBSAG HCV RPR WN Addendum C: Recommended Orders for Breast Milk Exposure Recipient s Mother

11 11 of 11 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy. Committees/Sections/Departments: Date Director/Responsible Owner: Vice President/Executive Director: Chief of Medical Operations: (if clinical policy or appropriate) Chief of Staff: (if clinical policy or appropriate) Pam Beitlich, Director 5/14/18 Connie Anderson, CNO 05/22/18 James Fiorica, M.D., CMO 05/24/18 Medical Executive Committee: (if clinical and review requested by CMO and COS) Chief Executive Officer: David Verinder, CEO 05/25/18

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