Prepare for the worst: Fortify newborn security
JCAHO may be the least of your concerns
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, requires that all physical security systems be identified and fully described in your security management plan, including uses, goals, and objectives. The systems must be operational at all times. If one is inoperative or not being used, it should be dismantled and removed, and alternative safeguards should be put in place.
Facilities at high risk for abductions must develop a written response plan that includes code words - many use "Code Pink" - that are communicated to the entire hospital at the time of a suspected abduction. The response plan should be evaluated and modified as necessary through periodic review and drills to ensure the intended outcomes.
George Stevens, associate director of the Joint Commission's department of standards, says surveyors want to see that an organization has addressed critical security concerns - that they've gone to the highest-risk area first and assessed security there. "Our requirements are the same for any size facility: merely that it address the situation," says Stevens. "Joint Commission standards are not prescriptive."
The maternity and nursery areas would be a high priority, as would laboratories, pharmacies, and emergency departments. The Joint Commission mandates that the organization assess its risk based on location and past experience, Stevens says, but even if a facility has had no bad experience, it must acknowledge that a risk exists.
"Surveyors make sure that birthing areas have a security plan and that the hospital has put in place engineering solutions to the point that it's possible to restrict access to the area to all but qualified persons," says Stevens. "The organization can choose to enact any number of security measures - they can be as simple as a matching bracelet system, or as elaborate as a system where an electronic device implanted in the bracelet or elsewhere on the baby sets off an alarm and stops elevators."
The Joint Commission would not be your only concern if a switch or abduction occurred at your facility. A hefty lawsuit almost certainly would follow, and with it public relations concerns and a damaged community image. All hospital employees charged with the safety of the switched or missing baby would be exposed to significant liability. A few years ago, an Oklahoma couple sued a hospital for $56 million after a newborn abduction, charging that the hospital was negligent for inadequately providing proper security. Similarly, in a 1993 baby-switching case, it was discovered that a Florida teenager had been sent home with another parent's baby. That hospital settled lawsuits by paying the families a total of $13.6 million.
The best defense against a liability action is to show that the hospital took reasonable steps to prevent the incident by having a well-prepared security policy and that staff followed the policy was followed by the staff. Make sure you have in place a fail-safe program to track babies from birth to hospital discharge, reinforced by mock drills every few months. New employees should be briefed on the security policy during orientation, and records should be maintained demonstrating that there are periodic reviews of the policy.
The following are recommended nursing staff guidelines during an abduction alert:
· Immediately notify security and other designated hospital authorities.
· Begin a complete unit search.
· Protect the immediate area to preserve forensic evidence.
· Brief staff members, and instruct them to advise all mothers. Remove affected parents to a room off the maternity floor, and assign a nurse to stay with them and provide support and protection from undue interferences.
· Hold group discussion sessions to assess and deal with post-traumatic stress disorder.
The following are security staff guidelines during an abduction alert:
· Notify the police and the Federal Bureau of Investigation.
· Begin an exterior search, securing exit points and perimeter.
· Go to the abduction site to obtain information and protect the crime scene.
· Maintain law enforcement liaison, brief facility spokespersons, help with notification of the media, and oversee control of the media on the premises.
· Notify other health care facilities in the area.
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