Certified Lactation Specialist Protocol Development & Review 3 — Questions and Answers
Question 1: Which type of clinical evidence is ranked HIGHEST when selecting references for a lactation protocol?
- Expert opinion and consensus statements
- Case reports and anecdotal evidence
- Systematic reviews and meta-analyses of randomized controlled trials (Correct answer)
- Single observational cohort studies
Correct answer: Systematic reviews and meta-analyses of randomized controlled trials
Systematic reviews and meta-analyses of RCTs represent the highest level of evidence in evidence-based medicine hierarchies.
Question 2: A lactation consultant is developing a protocol for management of late preterm infants (34–36 6/7 weeks). The protocol should emphasize monitoring for:
- Over-supply in the mother
- Inadequate milk transfer and hypoglycemia risk (Correct answer)
- Early introduction of complementary foods
- Formula preference development
Correct answer: Inadequate milk transfer and hypoglycemia risk
Late preterm infants have immature suck-swallow-breathe coordination and glycogen stores, making inadequate transfer and hypoglycemia primary concerns.
Question 3: An implementation plan for a new breastfeeding protocol should include a section on:
- Staff vacation scheduling
- Education and competency verification for all affected staff (Correct answer)
- Hospital marketing strategy
- Insurance reimbursement rates
Correct answer: Education and competency verification for all affected staff
Staff education and competency verification ensure the protocol is understood and applied correctly before go-live.
Question 4: A protocol's 'purpose' statement should be written to answer which core question?
- Who approved the protocol?
- Why does this protocol exist and what problem does it solve? (Correct answer)
- How much will the protocol cost to implement?
- When will the protocol be retired?
Correct answer: Why does this protocol exist and what problem does it solve?
The purpose statement articulates the clinical problem being addressed and the intended outcome of the protocol.
Question 5: A hospital's BFHI (Baby-Friendly Hospital Initiative) designation requires that protocols align with which foundational document?
- HIPAA Privacy Rule
- Ten Steps to Successful Breastfeeding (Correct answer)
- OSHA workplace safety standards
- ICD-10 coding guidelines
Correct answer: Ten Steps to Successful Breastfeeding
The WHO/UNICEF Ten Steps to Successful Breastfeeding are the core requirements that guide BFHI-compliant protocols.
Question 6: When a new systematic review is published that contradicts a current lactation protocol, the BEST immediate action is to:
- Immediately revise and re-distribute the protocol without committee review
- Ignore the new evidence until the next scheduled review cycle
- Flag the protocol for expedited review by the protocol committee (Correct answer)
- Remove the protocol from use entirely
Correct answer: Flag the protocol for expedited review by the protocol committee
Significant new evidence warrants flagging the protocol for expedited committee review to assess the need for revision before the next scheduled cycle.
Question 7: In a protocol for responding to breastfeeding refusal (breast refusal), which intervention should be listed as a FIRST-LINE assessment step?
- Recommending immediate supplementation with formula
- Evaluating for oral anatomical variations such as tongue-tie (Correct answer)
- Discontinuing breastfeeding for 48 hours
- Prescribing galactagogues
Correct answer: Evaluating for oral anatomical variations such as tongue-tie
Oral anatomical variations like ankyloglossia are common, correctable causes of breast refusal and must be assessed before other interventions.
Certified Lactation Specialist Protocol Development & Review 3
Which type of clinical evidence is ranked HIGHEST when selecting references for a lactation protocol?