How to Write an Effective Lactation Consult Care Plan
The care plan might be the most important document IBCLCs generate in our practices. Sure, our charts are essential for documenting what's going on with a dyad, and those superbills are critical for helping our clients fight for the reimbursement they're entitled to under the ACA. Pediatrician reports remind doctors that we are allied health professionals, part of a team working towards improving health outcomes through coordinated care.
But we know the reality--pediatricians don't read our reports, the insurance companies block reimbursement, and if we have a solo practice nobody's seeing our charts but us.
The care plan matters
The care plan, however, has one primary purpose: to communicate to our clients our recommendations, and provide them with resources to implement our recommendations at home after we leave.
Our clients need to be able to work on breastfeeding/chestfeeding without us because we're not there at 3 a.m. Whether you offer unlimited follow up or no follow up or somewhere in between, a care plan can eliminate a large amount of follow up by anticipating client's questions and giving them clear instructions and next steps.
Ideally, clients can take the care plan and use it without asking you any further questions at all. Of course we know in reality that's not always going to happen, even with the best care plan in the world, but the more detailed your care plan is, the more likely it is that most clients will require less follow up thereby giving you more time.
Elements of the care plan
Assessment. Use plan language that explains what you're seeing without jargon or judgement. "Your baby may have a tongue tie" vs. "Ankyloglossia." Instead of saying "down-regulation of milk supply," say something like, "Your factory seems to have slowed down and we're going to try to perk it back up." Include some positives as well, so clients can refer back to the positives when they are feeling discouraged.
Recommendations. Also known as protocols, recommendations give clients a plan of action. Be super clear here; give them step-by-step instructions and explain the effect they are expecting to see.
Interventions. For every intervention you recommend, include the risks of not performing the intervention. It reminds families that they are the ones who make the decisions, not you or anyone else.
Resources. Here is where you have an opportunity to get ahead of your clients. If you provide them with solid resources in the form of internet links to free articles (that of course you approve of), you can hopefully prevent them from Googling or crowd-sourcing the issues that they are facing. We know what happens next--they get confused, they get worried, and they come back to us with a million questions. By providing them with curated resources, we can satisfy their need to research the challenges their facing, and amplify our recommendations making them more likely to be implemented.
Follow up. Tell your clients how follow up works, including a clear timeline for when you expect to hear from them.
Referrals. Include the names and contact information for any referrals you are making. Include a website wherever possible as this may add legitimacy to the referral.
Saving time with your care plan
This is a lot of writing. You could easily spend a few hours crafting this care plan, and internet links aren't always in a form that's easy to remember or write down. Here's where being paperless will allow you to save time while being as thorough as you need to be.
Keep templates versions of all of your protocols, and use a format that will make it easy for you to update them as you tweak and refine your own protocols. You have several options for storing and accessing:
You could store them in Drive files, and copy and paste into the care plan.
You could use auto text through your operating system
I use an app called PhraseExpress, a more robust version of auto text. It keeps my protocols organized in folders and I can access it from my phone, iPad, or laptop.
Keep your links organized
You can include your links in your protocols, but I recommend keeping them separate so you can cherry pick the exact links you want to send someone, particularly if there are more than three awesome resources for a given topic.
I've been using Workflowy to organize my links, and recently invited my IBCLC colleague Jen Deshaies to collaborate with me because nobody curates links like her. What I love about Workflowy is the visual interface. It's just so pretty to use, and has an app for the iPad that I find very easy to use (it's also available for Android).
Having access to Jen's brain has been game changing for me. She finds things I didn't even know I was looking for, and every link is chosen to be client-friendly. We're not sending our clients ABM protocols (even though they are awesome), and we're not just sending them to Kellymom (even though we love her). We've got videos that are hard to find in search. We've got articles written by amazing IBCLCs who don't show up in Google. The best thing is that it dynamically updates. Whenever Jen or I add a new link, it shows up without having to refresh, redownload, or re-access. It's just automatically there.
If you're interested in adding this resource to your workflow, you can purchase access in my store. If you have a link you'd like to add to the resource, absolutely let me and Jen know by contacting us.
Sharing the care plan
Links can pose some challenges in sharing the care plan.
I learned the hard way that using the message feature in Mobile Lactation Consultant to send by email meant that often my care plans got flagged as "promotions" or spam and my clients didn't get them. No bueno!
I have tried converting SOAP notes into PDFs in Jane, but the links then need to be copied and pasted because they aren't clickable. Annoying!
Forget about using Spruce, the text-style format makes a long care plan basically illegible. Defeating the purpose!
I've come up with a workaround that creates an extra step, but is so client-friendly that it's worth it. For each of my clients, I create a file in my G-Suite Drive with their name. I put their entire care plan into that file, and then I share the file with my clients as view-only using the Share feature in G-Suite. It asks me if I'm sure I want to share it with someone outside my organization, adding an extra level of security. I also paste the link to the file into the care plan I'm sending them through my EHR.
Additionally, I paste this link into the pediatrician report with a message that says "I have provided my client with a comprehensive care plan including links to help improve client outcomes. You can view this client's detailed care plan using this link." This keeps my pediatrician reports simple and clean and easy for them to read, while ensuring that the pediatrician can see what I am telling my clients. Theoretically these care plans can also serve as breastfeeding advocacy and education for pediatricians if they read them. I've got one pediatrician in my area who has told me that he loves my care plans because they help him learn more about breastfeeding. From the rest--crickets. You know how it goes!
Now, if my client emails me that they are having trouble viewing the Drive file, I can then reply to that email with the entire care plan pasted into the email, links and all. Because it's an email reply, it won't get flagged as spam.
For subsequent visits, I update the Drive file and remind my client of the access link. I've been using this workaround for a few weeks now and so far feedback from my clients has been positive.
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About the Author
Annie Frisbie, MA, IBCLC is the creator of the Lactation Consultant Private Practice Toolkit, a collection of books, resources, legal forms, training manuals, and workbooks aimed at helping private practice lactation consultants build a private practice that’s ethical, profitable, sustainable, and enjoyable.