Cleft-lip and Palate Checklist

CLEFT-LIP AND PALATE CHECKLIST

Initial and date as each item is completed. Print your name at the bottom of the page.

Date Cleft Identified:____________________________

Within 24 hours of identification

*_____1. Order feeding consults (breast or bottle e). If on vent, then order within 24 hours post extubation (MD/NNP/PA)

Call the Lactation Consultant (2-2149)

Call Speech Pathology (2-2455) for help with establishing feeding

______2. Establish milk supply for mother whose infant is having difficulty breastfeeding (check with Nursing Staff)

For breast pump, if mother is still an inpatient, call the UNMH 4 Middle RN Case Manager (2-9195, 951-2508).

If mother from outside or discharged, call the NICU RN Case Manager (2-1410, 951-2504).

Within 72 hours

*______3. Order Dysmorphology Consult (2-5551) (MD/NNP/PA)

To determine if cleft is associated with a syndrome or is an isolated defect

For genetic counseling for the family (also provides handouts in English and Spanish).

______4. Order Speech Pathology Consult (22455)

For assistance with feeding and follow-up

______5. Obtain Developmental Care consult (2-3946)

For neurodevelopmental evaluation of infant

For help with family emotional adjustments, parent-infant connections, attachment

_____6. Obtain Otolaryngology Consult

Call ENT resident on call (2-2111), Dr. Erica Bennett, Dr. Tania Kraai, or Dr. Michael Nuara (2-2000)

(MD/NNP/PA)

For evaluation for future lip/palate/ear tube surgery and F/U

Before hospital discharge

______6. Identification of Primary Care Provider discussed with the family (check with Social Services)

______7. Arrange follow-up weight and hydration check (MD/NNP/PA)

To set up Home Health Nursing, contact the RN Case Manager/Discharge Planner (2-1410).

Set appointment with the infant’s primary medical provider for 48 hours following discharge

______8. Call for follow-up appointment with the UNM Cleft Lip and Palate Team (2-2290, 2-3202) (MD/NNP/PA)

Ask for Clinic Coordinator Mahshid or Sheree if there are questions.

______9. Establish whom the family will call if concerns arise (check with RN)

Pediatrician After D/C:________________________________ phone:__________________

UNMH Cleft Lip and Palate Clinic phone: 505-272-2290

PRINT YOUR NAME HERE IF YOU INITIALED ANY OF THE ABOVE:

____________________________________ ____________________________________

____________________________________ ____________________________________

____________________________________ ____________________________________

*BENCHMARK

Last revised 01-5-2011 SLP: Kathie Esquibel-Baca, MS, CCC-SLP