pathway for the management of mastitis in the lactating woman v1

Pathway for the management of mastitis in the Lactating woman V1

Pathway for the management of mastitis in the Lactating woman

Document Number PP-024

Version 1

Ratified By and Date Medicines Management Group 21 August 2014, SEOG 21January 2015

Name of Approving Body(s) and Dates

SACE South 11 September 2012

SACE North 8 October 2012

Medicines Management Group April 2014, 21 August 2014, SEOG 21 January 2015

Job Title of Document Author UNICEF lead breastfeeding South Health Visitor/BFI keyworker Consultant Microbiologist

Name of Responsible Committee Medicines Management Group

Executive Director Medical Director

Date Issued January 2015

Expiry Date (Maximum Two Years) January 2017

Target Audience Health Visitors and Breastfeeding Specialists working within the Trust

This document may be made available in a different format by contacting the Author of the Document


Version Control - Review and Amendment Log

Version Type of Change

Date Description of Change

1.1

1.2

Reformat

Changed from a protocol to pathway

01/04/14

01/04/14

Reformatted into new Organisation template

Previous protocol had PGD’s for Health Visitors. These have been removed. This is now a pathway to give guidance to manage mastitis.


DOCUMENT SUMMARY Document Title Pathway for the management of mastitis in the

Lactating woman

Document Status New Revision YES

Date of Publication

Original: June 2012 Revision: April 2014 –Jan 2015

Key Points

Mastitis is an inflammatory condition of the breast which may or may not be accompanied by infection (Australian guideline 2009). The inefficient removal of milk due to poor positioning and attachment of the infant at the breast is a significant contributing factor of mastitis. However, it has been reported that health professionals regard mastitis purely as an infection and are often not equipped to help such women deal with the contributing factors, and may also advise Mothers to stop breastfeeding. It is consequently imperative for health professionals to understand the aetiology, prevention and treatment of mastitis. This will then enable mothers to continue to successfully breastfeed and thus facilitate achieving of the Department of Health (DH) targets Promoting and supporting sustainable breastfeeding is an essential part of an integrated programme of child health promotion and parenting support as set out in the Healthy Child Programme (DH, DCSF 2009) and Every Child Matters (2003).

The pathway is written in conjunction with the requirements necessary for the Trust to achieve full UNICEF UK Baby Friendly Accreditation. UNICEF UK Baby Friendly accreditation is a structured programme with an external verification process. Full accreditation demonstrates compliance with set quality standards in relation to breastfeeding support services and infant feeding. A key recommendation of the NICE Guidance on Maternal and Child Nutrition (NICE 2008a) is that children’s services should adopt a multifaceted approach across different settings to increase breast feeding rates. This should include:

Activities to raise awareness of the benefits of, and how to overcome the barriers to, breastfeeding.

Training for health professionals.

Education and information for pregnant women on how to breastfeed, followed by proactive support during the postnatal period.

If initial treatment of mastitis symptoms are prompt, symptoms may resolve in 12 -24 hours, if not, they may progress (below) and become more severe whereby Medical treatment with antibiotics is recommended to help prevent further deterioration and possible abscess formation.


It is important to encourage and support the mother to breastfeed from the affected breast to aid recovery

If symptoms are not resolving or become more severe within approximately 12 -24 hours medical treatment with antibiotics is recommended to help prevent further deterioration and possible abscess formation. However, it is very important that the mother is advised to continue with the management of mastitis. Effective milk removal is an essential part of treatment.

Available Support Health visitors


Contents Page

1. Introduction

6

2. Purpose

6

3. Explanation of Terms

7

4. Duties & Responsibilities

7

5. Scope

5.1 Causes 5.2 Symptoms 5.3 Predisposing factors 5.4 Management 5.5 Other information 5.6 Support

8

9 9 9 9

12 12

6. Training & Resource Implications

13

7. Consultation, Approval & Ratification Process

13

8. Equality Analysis Summary

14

9. Monitoring Compliance with the Document

15

10. References & Supporting Documents

15

11. Policy Review

16

12. Appendices Appendix 1 – Health Visitor Role

Appendix 2 – Monitoring Compliance Appendix 3 -

Appendix 3 – Equality Analysis


Pathway for the management of mastitis in the Lactating woman

1. Introduction

Mastitis is an inflammatory condition of the breast which may or may not be accompanied by infection. The inefficient removal of milk due to poor positioning and attachment of the infant at the breast is a significant contributing factor of mastitis. However, it has been reported that health professionals regard mastitis purely as an infection and are often not equipped to help such women deal with the contributing factors, and may also advise Mothers to stop breastfeeding. It is consequently imperative for health professionals to understand the aetiology, prevention and treatment of mastitis. This will then enable mothers to continue to successfully breastfeed and thus facilitate achieving of the Department of Health (DH) targets.

2. Purpose

The main aim of this pathway is to standardise practice

The pathway is a statement of intent and it:

Supports the values of the Staffordshire and Stoke on Trent Partnership NHS Trust in relation to breastfeeding and infant feeding.

Outlines staff actions necessary to help mothers recognise the causes, prevention and early treatment of mastitis.

The pathway outlines the responsibility of the Trust to provide training in mastitis management, by way of the 3 day breastfeeding management course, to enable health visitors that have contact with lactating mums to provide full and competent support. The Objectives of this pathway is:

To ensure standards are clearly identified

To ensure that trained practitioners provide appropriate treatment for women with mastitis

Promoting and supporting sustainable breastfeeding is an essential part of an integrated programme of child health promotion and parenting support as set out in the Healthy Child Programme (DH, DCSF 2009) and Every Child Matters (2003).

The pathway is written in conjunction with the requirements necessary for the Trust to achieve full UNICEF UK Baby Friendly Accreditation. UNICEF UK Baby Friendly accreditation is a structured programme


with an external verification process. Full accreditation demonstrates compliance with set quality standards in relation to breastfeeding support services and infant feeding. A key recommendation of the NICE Guidance on Maternal and Child Nutrition (NICE 2008a) is that children’s services should adopt a multifaceted approach across different settings to increase breast feeding rates.

This should include:



Education and information for pregnant women on how to breastfeed, followed by proactive support during the postnatal period.

This pathway applies to Health Visitors and Breastfeeding Specialists who are registered with the NMC and who have undertaken the breastfeeding management training and have had their knowledge and skills assessed as competent

Health Visitors (along with midwives and GP’s) have the primary responsibility for supporting breastfeeding women and helping them to overcome related problems.

This pathway should be read in conjunction with the Infant feeding policy.

This pathway should only be used if the woman is breastfeeding or expressing breast milk. If woman using formula milk develops mastitis symptoms she must be referred to her GP

3. Explanation of Terms

For the purpose of this document, the following terms apply:

Term Explanation

Mastitis an inflammatory condition of the breast which may or may not be accompanied by infection

4. Duties & Responsibilities

Chief Executive The Chief Executive has overall responsibility for the strategic and operational management of the Trust, including ensuring that the Trust’s procedural documents comply with all legal, statutory and good


practice requirements. The Chief Executive is responsible for ensuring that there are safe and effective systems in place to deliver high quality care to the persons who use our services.

Director of Nursing & Quality The Director of Nursing & Quality has overall responsibility for the implementation of this pathway and delivery of care including standards for the management of mastitis in the breastfeeding woman. Support and advice will be provided by infant feeding leads. This pathway applies to all Staffordshire and Stoke on Trent Partnership NHS Trust Health Visitor employees, including bank staff, who have contact with breastfeeding mothers. Health Visitor Professional Leads, UNICEF Leads and Breastfeeding Specialists are responsible for promoting evidence based practice in the promotion and management of breastfeeding including overcoming barriers such as mastitis. The Partnership Trust’s UNICEF leads will work with Health Visitor professional leads / key workers/ breastfeeding specialists in developing and reviewing this pathway as necessary and participating in and reviewing training and audit in relation to it. Team Leaders are responsible for ensuring that staff are orientated to this pathway and attend appropriate training Individual employees are responsible for implementation of this pathway in relation to the information and support they provide for clients in relation to mastitis management

5.1 Scope

5.1. Causes:

Non-infective mastitis is due to immunological responses to milk . substances forced into the capillaries and connective tissue from the alveoli by high pressure. This causes inflammation and pain. Infective mastitis is less common and is caused by either infection on the outer skin of the breast or within the glandular tissue. Usually mastitis occurs unilaterally. If non-infective mastitis is not treated appropriately then this may develop into infective mastitis and then a breast abscess may form


5.2 Symptoms: Local or generalised swelling Lump or tender area which may feel hot to touch Breast pain – tender lump Inflammation – often wedge shaped The whole breast(s) ache and may become red. Slight pyrexia ‘Flu like’ symptoms -aching, increased temperature, shivering, feeling tearful and tired (this feeling can sometimes start very suddenly and get worse very quickly) Headache

If initial treatment is prompt, symptoms may resolve in 12 hours or so, if not, they may progress (below) and become more severe whereby Medical treatment with antibiotics is recommended to help prevent further deterioration and possible abscess formation Feels very ill Severe pyrexia Rigours Mums may not have all the signs (Morbacher and Stock, 2003) 5.3 Predisposing Factors 1. Ineffective breast drainage resulting from:-

Incorrect attachment at the breast

Missed feeds

Longer gap between feeds

Pressures on breast e.g. poorly fitting bra, from mum’s hands at feeds, baby’s hand/arm at feeds, handbag, baby sling, lying on breast

Mother giving formula instead of expressed breast milk

White Spot/Bleb 2. Sore cracked nipples 3. Stress 4. Poor physical health 5. Anaemia 6. Insulin Dependent Diabetic mother 7. Mouth/nose infection in infant 8. Breast trauma e.g. previous surgery, previous abscess, bruising 9. Lowered resistance to infection which may be attributed to smoking 10. Nipple piercing


5.4 Management

It is important to encourage and support the mother to breastfeed from the affected breast to aid recovery

The Role of the Health Visitor/ Breastfeeding Specialist

If signs and symptoms present-review without delay

Undertake breastfeeding assessment and observe position and attachment –help the mother make improvements.

Advise to feed 2-3 hourly, as often and for as long as the infant is willing including during the night for as long as pain persists.

Discuss pain relief

Identify predisposing factor(s) and give information and provide support.

Express at end of each feed until lump reduces /redness subsides

The Health Visitor/ Breastfeeding Specialist should support and encourage the mother to overcome mastitis by discussing self-help measures such as: -

Feeding from the sore side first for good drainage. Leaning over baby in an upright position may also encourage effective drainage.

Establish milk flow before putting baby to the breast - run warm water over the breast prior to feeds

Try different feeding positions - gravity feed or under arm hold may help

Use massage and heat to soften the breast.

Use a wide toothed comb with rounded teeth to stroke gently over the red area and towards the nipple to help milk flow.

Checking clothing to prevent continued pressure [a well-fitting bra is essential].

Relieving symptoms with cooling treatments such as cold flannels and gel-filled cool packs.

Rest, plenty of fluid and a good diet.

Homely remedies Avoid sudden changes in feeding practice, for example, longer than normal gaps between feeds which leave the breasts full for longer. NOTE: Patient should be advised to attend the GP if either the following two scenarios present. 1, If bilateral mastitis is present, as it is advised that a culture of milk from both breasts is taken to establish the responsible organism. 2, If mastitis is reoccurring it would be appropriate to test the milk for culture and sensitivity and also to obtain swabs from the infant’s nasopharynx and oropharynx to identify the offending organism.


If symptoms are not resolving or become more severe within approximately 12 - 24 hours then medical treatment with antibiotics is recommended to help prevent further deterioration and possible abscess formation, these may be prescribed by a non medical prescriber or referral to a Medical Practitioner is required at this point. However, it is very important that the mother is advised to continue with the management of mastitis. Effective milk removal is an essential part of treatment.

Medical Management

If the woman's symptoms do not improve after 12–24 hours despite effective milk removal, treatment with an antibiotic is indicated (Kvist et al, 2008).

If empirically treating infection:

Prescribe flucloxacillin 500 mg, four times a day, for 14 days. If patient is >80kg prescribe flucloxacillin 1g, four times a day, for 14 days.

An alternative (for patients with penicillin allergy) is erythromyc 500 mg, four times a day, for 14 days.

(Note this is inferior to 1st line treatment. Penicillin allergy should only be accepted as genuine hypersensitivity if convincing history of either rash within 72 hr of dose or anaphylactic reaction.)

Inform the woman that these antibiotics are only excreted in milk in very small amounts. Usually the infant is not affected, but occasionally stools may be looser or more frequent than usual or the infant may be more irritable.

If symptoms fail to settle after 48 hours of antibiotic treatment:

Check that the woman has taken the antibiotic correctly.

Advise the woman to attend the GP as a sample of the milk should be sent for culture.

Discuss with the GP.

If culture results are available, Gp will treat with an antibiotic the organism is sensitive to.


Consider an alternative diagnosis. If there is an underlying mass or ductal cancer or inflammatory breast cancer is suspected, the GP should arrange urgent investigation or referral.

If a localized area of the breast remains hard, red, and tender — suspect an abscess. Malaise and fever may have subsided if antibiotics have been taken. GP should refer the woman to a general surgeon for management urgently. If the woman has recurrent mastitis, the GP can liaise with the microbiologist or refer patient to a surgeon to look for an underlying cause. Pain relief

Ibuprofen* 400mg one tablet 3 times daily This considered the most effective as it reduces inflammation and pain (WHO 2000)

Adults -Paracetamol 2 x 500mg x four times daily, This is an appropriate alternative for the relief of pain (WHO)

12-16yrs Paracetamol 480-750mg 4-6 hrly, 16-18yrs Paracetamol

500mg -1g every 4-6 hrs max 4 doses in 24 hrs. * Check interactions and cautions with British National Formulary

5.5 Other information:

During mastitis the increased sodium levels in the milk resulting from the inflammatory process, can affect the taste of the milk resulting in the infant potentially refusing to feed from the affected breast. Also, there may be a drop in lactose in the milk due to the damaged alveoli tissue effecting milk synthesis, in the short term (Featherstone 2001) 5.6 Support Provide the mother with information about breastfeeding support session details, local and national breastfeeding telephone contact details. Provide follow up care and support as the cause needs to be ascertained and remedied to prevent reoccurrence


6. Training & Resource Implications

All Health Visitors, Breastfeeding Specialists, Nursery nurses and support staff who have contact with breastfeeding women and their families should be aware of this guidance.

All Health Visitors and Breastfeeding Specialists who are registered with the NMC will have undertaken the breastfeeding management training and have had their knowledge and skills assessed as competent

This pathway will be disseminated to Health Visitors initially through professional meetings.

It should be provided to new staff as part of their local induction and associated need for breastfeeding management training assessed (and this should be evidenced within local induction documentation later filed on staff personnel files).

7. Consultation, Approval and Ratification Process

Consultation

7.1 The pathway has been developed based on current best practice. Promoting and supporting sustainable breastfeeding is an essential part of an integrated programme of child health promotion and parenting support as set out in the Healthy Child Programme (DH, DCSF 2009) and Every Child Matters (2003).

The pathway is written in conjunction with the requirements necessary for the Trust to achieve full UNICEF UK Baby Friendly Accreditation. UNICEF UK Baby Friendly accreditation is a structured programme with an external verification process. Full accreditation demonstrates compliance with set quality standards in relation to breastfeeding support services and infant feeding. A key recommendation of the NICE Guidance on Maternal and Child Nutrition (NICE 2008a) is that children’s services should adopt a multifaceted approach across different settings to increase breast feeding rates. This should include:



Education and information for pregnant women on how to breastfeed, followed by proactive support during the postnatal period

7.2 This document was previously circulated as a draft to All SSOTP Health Visitors, Medicines management group, Infant feeding leads,


Some GP’S, South Division management team, locality managers, HV Implementation group, CPT’S, APG and the SACE North and South groups in 2012. This revision was re-circulated to all Health Visitor team leaders, Medicines management group, Children’s services management team, CPT’s, BFI keyworkers, Microbiologist, Medical director and infection Control lead April 2014.

8. Equality Analysis Summary 8.1 An equality Impact assessment was completed to ensure its consideration to the impact on local vulnerable people and those from the protected equality groups. 8.2 Staffordshire & Stoke on Trent Partnership NHS Trust considers how the decision it makes affects people who share different protected characteristics (race, disability, sex, gender re-assignment, religion/belief, sexual orientation, age, marriage and civil partnership, pregnancy and maternity). The Trust also recognises that there are groups/communities that are recognised at a local level within society as excluded or disadvantaged in addition to those listed as protected groups above and this document is inclusive to these groups also for example, young teenage parents, homeless people etc.

This pathway has been developed with due regard to relevant legislation, MCA (2005), Equality Act (2010) and best practice guidance. The pathway clearly sets out the framework in which all staff employed or working on behalf of the organisation must work in relation to managing mastitis. The pathway promotes a positive approach towards and includes all equality groups as identified by the legislation (Equality Act 2010). An equality analysis of this pathway has been undertaken to ensure it is fair and accessible, compliant with legal and best practice guidelines.

The Pathway for the management of mastitis in the Lactating woman sets out the best practice regarding delivering a minimum standard of quality care, equally accessible to lactating women with signs/symptoms of mastitis. This fits well with ensuring fair and quality care for all. The equality analysis indicates that the pathway will meet equality inclusion criteria ; cost implications in terms of resources and

training to meet the requisite standards will be negligible because mastitis is already covered in the UNICEF accredited training curriculum and this pathway will act as a supporting practice document.

A completed equality analysis is presented at (Appendix 2 ) of this document.


9. Monitoring Compliance with the Document

The pathway will be monitored via the UNICEF auditing process which entails Internal / External audits by SSOTP and UNICEF

Anecdotal feedback from mums who say they may have given up breastfeeding due to mastitis but carried on due to timely treatment and support.

Data reports around primary and 6-8 week breastfeeding rates.

Achievement of full UNICEF accreditation which will demonstrate that at least 80% of clients are receiving the care and support they need to breastfeed their baby.

10. References and Supporting Documents 10.1 References Clinical Practice Guideline. Breastfeeding Challenges – Mastitis and breast abscess. Australian guideline 2009. Cusack L, Brennan M. Lactational mastitis and breast abscess – diagnosis and management in general practice. Aust Fam Physician. 2011 Dec; 40(12):976-9. Featherstone, C [2001] Mastitis in Breastfeeding Women: Physiology or Pathology? Midirs: 12: 2: 235-240. Foxman, B [2002] New Insights with Regard to risk Factors for Lactation Mastitis: American Journal Epidemiology: 155: 103-114. Hale, T [2010] Medications and Mothers Milk 14th Edition: Hale Publishing: Texas. Healthy Child Programme (DH, DCSF 2009). HM Government (2003) Every Child Matters: change for children. London; HMSO. Available at www.everychildmatters.gov.uk/ Inch, S [2006] Breastfeeding Problems: Prevention and Management: Community Practitioner: 79: 5: 164-166. Jones, W., Sachs, M [2009] Mastitis and Breastfeeding: The Breastfeeding Network: BFN: Scotland. http://www.breastfeedingnetwork.org.uk/pdfs/BFN_Mastitis.pdf Kvist, l., Wilde Larsson, B., Hall-Lord, M [2008] The Role of Bacteria in Lactational Mastitis and Some Considerations of the Use of antibiotic Treatment: International Breastfeeding Journal: 3: 6.

http://www.everychildmatters.gov.uk/

http://www.breastfeedingnetwork.org.uk/pdfs/BFN_Mastitis.pdf


Mohrbacher, N., [2010] Breastfeeding Answers Made Simple: La Leche League: Illinois. NICE Guidance on Maternal and Child Nutrition (NICE 2008a).

NICE Clinical Knowledge Summaries. Mastitis and Breast abscess. May 2010 UK Baby Friendly Initiative (1994) Introducing Baby Friendly Initiative into the UK. London; UNICEF UK. www.babyfriendly.org. World Health Organisation [2000] Mastitis: Causes and Management: World Health Organisation: Geneva.

Other associated documents

This pathway must be read in conjunction with the Trusts Infant feeding policy, postnatal guidelines and any other relevant corporate documents.

11. Policy Review

This pathway will be reviewed in two years following ratification or sooner if the necessity arises.

http://www.babyfriendly.org/


Appendix 1 The Role of the Health Visitor / Breastfeeding Specialist

Practice

Rationale/Research

Mothers presenting with the signs and symptoms of mastitis should be reviewed by the Health Visitor without delay.

If mastitis is not treated promptly a bacterial infection and breast abscess may develop [Inch, 2006; World Health Organisation, 2000, Cusack L, Brennan M, 2011]

The Health Visitor/ Breastfeeding Specialist should encourage the mother to continue breastfeeding as often and for as long as the infant is willing – aiming for at least 8-12 times in 24 hours. To achieve effect milk removal the mother may also need guidance on expressing breast milk [Featherstone, 2001].

Removing milk from the breast is essential to relieve the pressure and help clear any blockages. Stopping breastfeeding at this point may actually make mastitis worse [Featherstone, 2001, Australian guideline 2009]. Expressing gently after feeds or when the breast[s] are uncomfortably full using either her hand or a breast pump, will help ensure the breasts are kept as well drained as possible [Jones and Sachs, 2009 Australian guideline 2009].

Pain should be treated with a suitable analgesic. Medical treatment may also be recommended. Effective pain relief includes paracetamol and/or ibuprofen.

To reduce pain, inflammation and temperature [Hale, 2010; WHO, 2000 Australian guideline 2009, Cusack L, Brennan M, 2011, ]

The Health Visitor/ Breastfeeding Specialist should assess positioning and attachment of the baby at the breast and if necessary help the mother make improvements. Unrestricted baby led feeding should be recommended.

As mastitis starts with poor milk drainage, good positioning, attachment and effective milk transfer at the breast is essential [Jones and Sachs, 2009; Mohrbacher, 2010]. Unrestricted baby led feeding is recommended to reduce the risk of mastitis reoccurring [Inch, 2006].

The Health Visitor/ Breastfeeding Specialist should support and encourage the mother to overcome mastitis by discussing self-help measures such as: -

Feeding from the sore side first for good drainage. Leaning over baby in a upright position may also

Women often feel unwell and find mastitis painful and frustrating. They may even wish to discontinue breastfeeding [Mohrbacher , 2010]. It is really important that the mother continues breastfeeding. Removing milk from the breast is essential to relieve the pressure, help clear blocked ducts and engorgement


encourage effective drainage.

Establish milk flow before putting baby to the breast.

Try different feeding positions.

Use massage and heat to soften the breast.

Use a wide toothed comb with rounded teeth to stroke gently over the red area and towards the nipple to help milk flow.

Checking clothing to prevent continued pressure [a well fitting bra is essential].

Relieving symptoms with cooling treatments such as, cold flannels and gel-filled cool packs.

Homely remedies

Rest, plenty of fluid and a good diet.

Avoid sudden changes in feeding practice, for example, longer than normal gaps between feeds which leave the breasts full for longer.

[Jones and Sachs, 2009].

It is important for the Health Visitor/ Breastfeeding Specialist to reassure the mother that the breast milk will not harm her baby even if an infection is present [Foxman, 2002]

To ensure the mother does not abstain from breastfeeding. Fresh human milk is normally not a good medium for bacterial growth. Infective mastitis results when milk stasis remains unresolved and the protection by the immune factors in the milk and by the inflammatory response is overcome [Kvist et al, 2008].

The Health Visitor/ Breastfeeding specialist should advise referral to a Medical Practitioner if symptoms are not resolving or become more severe within approximately 12-24 hours. Medical treatment is recommended to help prevent further deterioration and possible abscess formation. However it is very important the mother is advised to continue with the self-help management of mastitis as well. Effective milk removal is an essential part of treatment.

Mastitis can either be non-infective or infective. Infective mastitis should be treated with antibiotics in addition to regular milk removal [Morbacher, 2010]. A prompt clinical diagnostic test for infective mastitis has not yet been developed, therefore, all cases of mastitis which have not improved after 12-24 hours of improved milk removal should be treated as infective [Inch, 2006; World Health Organisation [WHO], 2000].


Occasionally the baby may be reluctant to feed from the affected breast because the infection may make the breast milk salty, in which case the mother will need to express milk manually or by using a breast pump

Most antibiotics can be safely taken whilst breastfeeding [Hale, 2010; WHO, 2000]. It is important that the mother finishes the whole course of antibiotics to ensure a full recovery and also to help prevent the mastitis coming back [Jones and Sachs, 2009]


Appendix 2

MONITORING COMPLIANCE

Name of Procedural Document

Pathway for the management of Mastitis in the Lactating woman.

Monitoring Officer UNICEF Implementation leads North /South

Reporting Arrangements Baby Friendly keyworker group – Bi-monthly HV Team meetings – Bi-monthly

Element to be Monitored - NSLA Criteria Tool Change in Practice and Lessons to be

Shared

Timeframe Nominated Lead Ref Standard Criteria

Staff education standard which meets UNICEF BFI accreditation

UNICEF audit tools Update training 6-12 monthly UNICEF Leads

Patient Feedback from breastfeeding support group evaluation

Evaluation tool Update training quarterly Breastfeeding support group

leads

Data for primary/6-8 week breastfeeding status

SSOTP data reports ongoing UNICEF Leads


Appendix 3

EQUALITY ANALYSIS Pathway for the management of mastitis in the Lactating woman

STEP 1: What is the background and starting point for this pathway? 1.1 This is a new pathway. Currently there is no local guidance on how to manage mastitis in the lactating woman. Mastitis, if left untreated at worst can cause a breast abscess and at least may lead to a woman being wrongly advised to give up breastfeeding. 1.2 The pathway fits with the organisational objective/values of

Providing high quality and safe services which provide excellent experience and best possible outcomes

Empowering and supporting the workforce to deliver care in a way which is consistent with our values

Putting quality first

Be user focussed and responsive

Be respectful and caring of people 1.3 Health Visitors and FNP nurses who have undertaken breastfeeding management training and who are SSOTP employees are responsible for the implementation of this Pathway.

STEP 2: What do we want to achieve?

To ensure that all mothers are given timely information/ treatment to treat and reduce the complications that mastitis may cause.

To ensure that staff who are involved with supporting women with breast feeding receive essential training to enable them to support women with mastitis symptoms/diagnosis

Supporting mothers to breastfeed which is key to reducing health inequalities.

Who is the target audience?

Lactating women, health visiting staff, staff returning to work and who are breastfeeding.

The aim of this pathway is to ensure a quality standard of care is given to lactating women with symptoms/signs of mastitis. It will not discriminate against any of the equality groups

Without the pathway, there is a potential for larger costs to the


organisation if mastitis turns into a breast abscess and incurs costs in terms of physical, psychological and emotional scarring to a woman who has to undergo an operative procedure to treat an abscess and financial costs of surgery.

STEP 3: What do we know?

Department of Health (2004a) Good Practice and Innovation in Breastfeeding

NICE.: www.nice.org.uk/Guidance/PH11/Guidance/pdf.English

UK Baby Friendly Initiative (1994) Introducing Baby Friendly Initiative into the UK. London; UNICEF UK

Continuous programme of audits using UNICEF tools to establish staff knowledge and skills, and information given to antenatal and postnatal women in relation to infant feeding

Anecdotal evidence suggests that breastfeeding mums find accessing GP’s for early diagnosis and treatment of mastitis very difficult.

Health visitors undergo extensive breastfeeding management training to support breastfeeding women. Mastitis is generally caused by poor positioning and attachment of the baby at the breast. Therefore they are best placed to carry out a positioning and attachment assessment to determine reasons for mastitis symptoms and to possibly prevent further deterioration to full blown mastitis.

If mastitis signs and symptoms are detected and support given to resolve in a timely manner this is likely to prevent the need for medication and further deterioration and support breastfeeding continuance

If mastitis is treated with a medical prescription given by a GP or nurse prescriber, Health visitors, FNP nurses and infant feeding team staff are best placed to support the woman.

STEP 4: What consultation has been taken: engagement and involvement 4.1 This pathway is a revised document. It was sent out in 2012 and again in

March/ April 2014. It has been shared with Health visitors, children’s service managers, medicines management, microbiologist and medical lead, a number of GP’s and infant feeding leads and the SACE groups North and South 2012.

In terms of involvement, the Continuous programme of audits using UNICEF tools will establish staff knowledge and skills, and information and support given to women who are breastfeeding.

Client satisfaction surveys at breastfeeding support groups will help ascertain women’s views on their care.

Feedback from staff members and mums with mastitis about the lack of consistency in the diagnosis and treatment of mastitis in the community

4.3 Training and updates are planned according with findings/outcomes of the UNICEF audits.

STEP 5:

The impact of the pathway is that it will standardise and improve care given to the identified client groups. There is a positive impact on woman across age, disability, faith etc since the pathway promotes

http://www.nice.org.uk/Guidance/PH11/Guidance/pdf.English


universal support and education to mums wishing to b/f babies and the inclusive approach enables education and support to be at the pace and in the format most suitable to the mother.

Actions identified within the pathway will have minimal cost implications. Mastitis treatment and diagnosis is already part of the breastfeeding training curriculum. This pathway will support the existing breastfeeding training which takes place over 3 days.

STEP 6: Have you identified any actions: The pathway will support existing breastfeeding training and give further guidance

to manage mastitis in the our practice based community.

STEP 7: How will we know that the pathway has been successful? 7.1 The pathway will be reviewed annually or as new information comes to light.

UNICEF Audits will show that staff can demonstrate the knowledge and practice advice they give to breastfeeding women in relation to managing mastitis and that breastfeeding women with mastitis were given the correct information/support to prevent/manage mastitis.

Anecdotal feedback from mums who say they may have given up breastfeeding due to mastitis but carried on due to timely treatment and support.

Monitoring of breastfeeding rates.

Achievement of full UNICEF accreditation which will demonstrate that at least 80% of clients are receiving the care and support they need to breastfeed their baby.

7.2 as above and

Via health visitor team leaders, health visitor team meetings and updates

SSOTP NHS Trust have set up a web page re breastfeeding information

STEP 8: Executive Summary

The Pathway for the management of mastitis in the Lactating woman sets out the best practice regarding delivering a minimum standard of quality care, equally accessible to lactating women with signs/symptoms of mastitis. This fits well with ensuring fair and quality care for all.

The equality analysis indicates that the pathway will meet equality and inclusion criteria; cost implications in terms of resources and training to meet the requisite standards will be negligible because mastitis is already covered in the UNICEF accredited training curriculum and this pathway will act as a supporting practice document