Revised 10/1/13 Replaces version dated 12/1/05
240.85 Issuing Breastfeeding Equipment Overview
This policy presents guidelines for WIC agency staff to follow when providing breast shells, supplemental nursing systems, or breast pumps to a WIC participant. These items are provided to Iowa WIC participants at no charge to the participants.
Although breast pumps are not a universal need of breastfeeding mothers, they have a place in breastfeeding support programs. Most women, in normal circumstances, can establish and maintain lactation without using a breast pump. For some women, hand expression meets their needs to maintain comfort or express milk for later feeding. Breast pumps may be needed to: Extend breastfeeding duration or Establish lactation and then maintain it. Note: Local agencies may provide breast pumps only during the postpartum period and only as needed.
Breast shells and supplemental nursing systems are listed in the agency budget under Category E—Supplies. Although not addressed in this policy, nursing bras and pads are also acceptable breastfeeding promotion expenditures in this category. Breast pumps, collection kits, rental fees, and shipping and handling costs for these items are reimbursed using food funds. This process is separate from the local agency budget process. See Policy 315.41 for more information.
Staff involved in process
Breast pumps may be authorized and issued by any local agency personnel qualified to be a competent professional authority. See Policy 310.05. Continued on next page
Iowa Department of Public Health/WIC CERTIFICATION Policy and Procedure Manual
Data system documentation
The WIC data system can be used to record the following information about breast pumps: Date issued Type of pump Serial number Rental company/organization Reason for issuance Date due (for electric pumps intended for multiple users)
The following reports can be generated from the WIC data system: Breast Pumps Due Report (participants that currently have pumps assigned in order by due date and reason issued) Breast Pumps Issuance Report (pumps currently in use by serial number, mother’s name, date issued, due date and reason issued) Breast Pumps Issued (number of pumps issued by pump type)
MPSF: WC-99-36 P Breast Pumps as a Food Cost. MPSF: WC-95-18 Providing Breast Pumps to WIC Participants. National Association of WIC Directors: Guidelines for WIC Agencies Providing Breast Pumps. Position Paper 08-002.
In this policy
This policy contains the following topics. Topic Breast Shells Supplemental Nursing Systems Manual Breast Pumps Options for Providing Electric Breast Pumps Electric Breast Pumps and Collection Kits Documenting Provision of Breastfeeding Equipment Electric Breast Pump Rental Agreement Electric Breast Pump Loan Agreement Physical Inventory Control Pumps Returned Damaged Lost Pump Participant with Pump Moves
See Page 3 4 5 7 8 11 12 13 14 14 15 15
Purpose of breast shells
Breast shells can be helpful for women experiencing: Flat or inverted nipples, or Sore nipples.
Choosing a breast shell
Breast shells come with rings in two sizes. Choose the proper ring size for the type of problem the woman is experiencing. Problem Flat or inverted nipples
Issuing breast shells
Ring to use Ring with smaller opening gently applies pressure to help force out nipple (use during pregnancy or lactation). Ring with larger opening promotes healing by creating ample air circulation and protects the nipple from friction between feedings (use during lactation).
Follow these steps when issuing breast shells to a participant. Step 1 2 3 4 5
Action Open the package and demonstrate how to assemble the shells. Review the instructions for assembly and cleaning included with each set of shells. Discuss how long to wear (refer to breast shell instructions, lactation consultant, or other qualified lactation resource). If shells are used for sore nipples, provide additional education on prevention and treatment of that condition. Generate a nutrition care plan in the WIC data system and document the provision of breast shells (see page 11 for more information about requirements).
Note: Breast shells should not be returned to the WIC agency once issued.
Follow up with participant
Follow up with the pregnant participants regarding concerns or questions within a month of issuing breast shells. The contact may be by telephone or during check distribution. Note: Nipple soreness postpartum requires follow-up sooner and until resolved.
Supplemental Nursing Systems
Reasons for use
Possible uses for a supplemental nursing system include: An adopted baby A baby with special physical needs requiring extra supplements, and A baby who needs an immediate supplement because the mother’s milk supply is low.
When to issue
A breastfeeding dyad using a supplemental nursing system requires careful follow up and evaluation by someone experienced in working with high-risk breastfed babies. Therefore, WIC agencies should issue supplemental nursing systems at the recommendation of the baby’s health care provider and/or lactation consultant.
Issuing the system
Follow these steps when issuing a supplemental nursing system to a participant. Step 1 2
3 4 5 6 7
Action Discuss the participant’s plans for using the system and what supplement will be fed (expressed breast milk or formula). Provide information on safe practices for storing and handling expressed breastmilk or mixing formula as needed (see Policy 215.61). Open the kit and discuss how tubing size and placement of the supplement container affect the flow. Review the importance of good positioning and latch on. Review cleaning instructions. Discuss follow-up plans with the baby’s health care provider or the lactation consultant. Generate a nutrition care plan in the WIC data system and document the provision of the supplemental nursing system (see page 11 for more information about requirements).
Note: Supplemental nursing systems should not be returned to the WIC agency once issued.
Follow up with the participant
Within a few days of issuing the system, follow up by telephone with the participant regarding concerns or questions.
Manual Breast Pumps
A manual pump is a breast pump that is intended for a single user. It may be powered by the user (usually through arm and hand movements), a battery, or a small electrical motor.
Reasons for using a manual breast pump
A breastfeeding woman may choose to use a manual breast pump when she: Has recurrent problems with engorgement, or Wants to pump breastmilk for missed feedings due to work, school or other activities.
There are a variety of manual pumps and the costs vary significantly between pumps. A pump that works well for one mother may not work for another. Therefore, it is important to offer more than one manual pump. Factors to consider when deciding which manual pump to issue to a woman follow: Availability of an electrical outlet Time allowed for pumping breaks How often the pump will be used (i.e., occasionally vs. several times a day) The woman’s experience and success using a breast pump How long the mother plans to breastfeed Cost comparison between the available pumps Continued on next page
Manual Breast Pumps, Continued
Issuing a pump
Follow these steps when issuing a manual pump to a participant. Step 1 2 3 4 5 6 7 8
Action Discuss the participant’s plans for pumping breastmilk. Provide information on storing breastmilk, if needed. Open the pump kit and demonstrate how to assemble the pump. Review the instructions for assembly and cleaning included with the pump. Take the pump apart and ask the participant to assemble it. Pack the assembled pump and other accessories in the bag provided in each kit. Provide information on safe practices for storing and handling expressed breast milk (see Policy 215.61). Document the issuance of the pump in the WIC data system. Generate a nutrition care plan as needed to record additional information (e.g., follow-up plans, evaluation of her understanding).
Note: Although some manufacturers report that manual breast pumps can be autoclaved for use by another woman, it is the policy of the Iowa WIC Program to issue these pumps to a single user. The pumps should not be returned.
Follow up with participant
Follow up with the participant regarding concerns or questions within a month of issuing the pump. The contact may be by telephone or during check distribution.
Options for Providing Electric Breast Pumps
Local WIC agencies have two options for providing electric breast pumps: Purchasing pumps and loaning them to participants. Negotiating reduced rental fees with local rental stations, then the local agency pays the rental fee for participants.
An electric pump is a hospital grade pump intended for multiple users over time in rental or loan programs.
Factors to consider
There are many factors to consider when deciding whether to purchase or rent electric breast pumps. Some key factors include the following: Usage patterns Availability of refurbished pumps Local rental fees Available staff time for participant education Access to rental stations
Local agencies that directly purchase electric pumps for loan to participants incur the financial liability of lost or damaged breast pumps. However, this option may still be cost effective for some agencies.
Local agencies may negotiate rental fees with third parties (local rental stations, pump manufacturers, hospital pharmacies, and lactation consultants) to provide pumps to WIC participants. It is strongly recommended that the contract or agreement specify each agency’s responsibilities for education and follow up. This arrangement may be formalized through a contract or agreement. This option transfers liability for equipment loss or damage from the local agency to the third party. This option may be cost effective for agencies with low usage patterns, reasonable local rental fees, and good access to rental stations. Note: Local agencies may not contract or negotiate rental agreements with third parties that have affiliations with WIC personnel.
Evaluate other sources of payment
When a pump is medically needed, there may be other sources of payment available for the pump. Examples follow: Private insurance and other sources of medical assistance (such as Medicaid), and Hospital discharge equipment for breastfeeding women.
Electric Breast Pumps and Collection Kits
A collection kit includes the parts of a breast pump assembly that touch the woman’s breasts and collects the milk. It may also be referred to as a breast pump kit, pump attachment kit, personal kit, or accessory kit. Collection kits are available for single- and double-pumping. Although some manufacturers report that collection kits can be autoclaved and then used by another woman, it is the policy of the Iowa WIC Program to issue these kits to a single user. The kits should not be returned to the local WIC agency.
Reasons for providing an electric breast pump
Electric breast pumps are an allowable expense when a WIC participant has a critical need involving the separation of a mother and infant, or a medical problem. The following reasons are acceptable for providing an electric pump: Mother or infant is hospitalized, Premature infant is unable to nurse effectively, Infant has severe feeding problem (e.g., cleft lip or palate), Infant is sick and unable to nurse, Mother is sick for an extended period of time, Mother is on medication that is contraindicated for breastfeeding, Mother and infant are separated for more than 24 hours, Mother has twins or triplets, Mother is physically unable to use a manual breast pump, or Other reasons as approved by the local agency Breastfeeding Coordinator.
Participants who work or go to school
Breastfeeding mothers who work or go to school should first be taught to hand express or use a manual pump. An electric pump may be provided for a participant who works or goes to school if she: Has work breaks that are no longer than 15 minutes, or Has been unsuccessful in using a manual pump. Note: Confirm that the participant has access to an electrical outlet at work or school to use the pump. Continued on next page
Electric Breast Pumps and Collection Kits, Continued
Issuing a pump
Follow these steps when issuing an electric breast pump for a participant. Step 1 2
Action Complete the appropriate written agreement with the participant and file a copy in the participant’s record. Refer to the table below for the next step. IF… Renting the pump
Loaning the pump
3 4 5
Extend loan or rental agreement
THEN… Call the rental station to: Provide the name of the person who will be using the pump, and Ask that the bill be sent directly to your agency. Demonstrate how to assemble the pump and collection kit, Take it apart and ask the participant to assemble it, and Review the instructions for cleaning the pump.
Write an alert in the WIC data system for the month the pump should be returned as a reminder to withhold checks if necessary. Provide information on safe practices for storing and handling expressed breastmilk (see Policy 215.61). Generate a nutrition care plan as needed to record additional information (e.g., follow-up plans, evaluation of her understanding).
If the participant needs to extend the loan or rental agreement, she must notify the WIC agency before the agreement ends. Keep an agency file to help track electric breast pumps. Note: You cannot deny a participant WIC benefits for failing to return a breast pump. Continued on next page
Electric Breast Pumps and Collection Kits, Continued
Follow up with participant
Follow up with the participant regarding concerns or questions within a month of issuing the pump. The contact may be by telephone or during check distribution. If loaning the pump and the mother/baby dyad is high risk, make an initial contact within 48 hours and schedule a weight check.
Communicate with health care provider
Communicate with the primary health care provider to coordinate services, particularly for high-risk mother/baby dyads. Use the standard WIC forms (Referral from the Iowa WIC Program and Request for Information form) for this communication.
Documenting Provision of Breastfeeding Equipment
Breastfeeding equipment is a significant investment of WIC resources. Local WIC agencies providing this equipment may be liable for injury to WIC participants resulting from improper use. This applies whether equipment is given, sold, or loaned. Therefore, local agencies should take reasonable steps to document the provision of breastfeeding equipment to: Insure against loss or damage through participant release, Obtain participant’s signature documenting her understanding of the terms of the rental or loan agreement, Document education provided and participant’s understanding of the information, and Manage the physical inventory.
Nutrition care plan requirements
A nutrition care plan is required in the participant’s record when breast shells and supplemental nursing systems are provided. The plan must include the following: Item provided Summary of counseling provided Reason for providing the item An evaluation of her understanding about using and cleaning the item Any follow up plans Note: The date and staff person signature are automatically recorded by the data system.
Written agreement required for electric pumps
A written agreement between the participant and the local WIC agency is required when electric pumps are rented or loaned. These agreements collect contact information to facilitate follow-up, explain the terms of the agreement, and obtain the participant’s signature agreeing with those terms. Note: See pages for 12-13 for copies of the agreements made available by the state WIC office. Both agreements are printed as two-part NCR forms.
Electric Breast Pump Rental Agreement
The Iowa WIC Program agrees to pay electric breast pump rental fees for:
Name: Address: City/State/ZIP: Home phone/cell number Work phone: Family I.D. Number(FID): Agreement period: (fill in start and end dates)
__________________ to ___________________
Reason for rental:
Alternate contact: Name of relative/friend:
If I need to renew this agreement, I must contact the WIC agency before the ______ day of the each month. If I do not renew this agreement before it expires, I will pay for all rental fees after the expiration date. The monthly fee is $_____________. I will return the pump undamaged and in working order or I must replace it. The replacement fee for a new pump is $_______________. I will return the pump in useable and clean condition. I will immediately report any problems with the pump to the rental station. I understand that the WIC Program, its employees, nor the Iowa Department of Public Health, is responsible for any personal damage caused by the use of this breast pump. The responsibility of the pump and its use is mine alone.
Authorized WIC staff signature
Electric Breast Pump Loan Agreement
The Iowa WIC Program agrees to loan an electric breast pump to:
Name: Address: City/State/ZIP: Home phone/Cell number: Work phone: Family I.D. Number(FID): Reason for issuing:
Alternate contact: Name of relative/friend:
I will return the pump or renew this agreement with WIC on or before ________________. If I do not return the pump by this date, I may need to pay the monthly fee of $______________. I will return the pump undamaged and in working order or I must replace it. The replacement fee for a new pump is $_______________. I will return the pump in useable and clean condition. I will immediately report any problems with the pump to the WIC agency. I have been shown how to operate and care for this pump and understand how to use it. The breast pump is for my use only. I understand that a limited number of electric pumps are available for loan. If another mother has a critical need for a pump, I may be asked to return the pump before the agreement expires. I understand that the WIC Program, its employees, nor the Iowa Department of Public Health, is responsible for any personal damage caused by the use of this breast pump. The responsibility of the pump and its use is mine alone.
Date issued: Date returned:
Authorized WIC staff signature Date _________________ Pump serial/tag number: _____________________ _________________
Physical Inventory Control
The purchase, distribution and recovery of breast pumps should be managed like any other type of agency procurement in order to prevent theft or unauthorized use or distribution.
All pumps and collection kits should be stored in an area or cabinet that can be locked when local agency personnel are not present. Note: All new pumps and collection kits should be stored in unopened packaging, as received from the manufacturer.
Service and maintenance
Local WIC agency policies should identify: Which staff members are responsible for cleaning, disinfecting and maintaining breast pump motors, The recommended maintenance schedule, and Procedures for retrieving pumps that are lost, stolen, or otherwise not returned.
The breast pump reports available from the WIC data system can be used to manage the inventory.
Pump returned damaged
Pumps returned to the agency damaged should be repaired, if cost effective, by the pump company at no cost to the participant. Local agencies will need to decide if it is cost effective to get the damaged pump repaired based on the replacement cost of a new pump. Continued on next page
Physical Inventory Control, Continued
Retrieving a WIC-owned electric multi-user breast pump procedure: 1. Attempt to reach participant or alternate contact by phone using the Electric Breast Pump Loan Agreement information. 2. If unable to contact by phone, send a certified letter to the participant. Notify participant if breast pump is not returned promptly local authorities may be contacted. 3. Request assistance from law enforcement depending on the pump’s current value. Keep in mind that not all local law enforcement will take action when you request assistance. Note: You cannot deny a participant WIC benefits for failing to return a breast pump.
Participant with pump moves
If a participants moves out of the local agency service area while in the possession of a WIC-owned electric breast pump, the following should be done: The local agency the participant moved from must contact the new agency to make arrangements for the pump to be returned to the agency the client left. The agency the participant is coming into must contact the client to see if a pump is still needed, if yes then make arrangements for the client to receive a pump. Note: It may not be feasible for the client to return the breast pump to the old agency in which case the new agency must mail or make other arrangements to get the pump back to the agency that issued the pump.
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