Newborn security: Steps toward minimizing your vulnerability
Ensuring that Mom can recognize her own baby is a good first step
Your procedures and policies on infant security warrant an especially close look in light of the notorious "baby switch" that's currently plaguing quality colleagues at the University of Virginia Medical Center in Charlottesville. (See article on p. 181.) Some quality managers on the front lines who have long experience in dealing with surveyors from the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations insist that this media-hyped incident will attract specific attention to management of environment of care issues, especially as they regard newborn security. They say the agency often responds to national news stories by instructing surveyors to target related deficiencies.
"Not so," says Russell Massaro, MD, executive vice president for accreditation operations at the Joint Commission. "Nursery security has been in our standards and a part of our process for years." (See article on surveying for newborn security, p. 179.)
In any case, now is as good a time as any to develop an effective security system in your nursery and maternity departments to make yourself less vulnerable to a baby switch and prevent a newborn abduction. "If we as medical workers do our jobs correctly every time, we can minimize baby switching," says Ann Ropp, vice president for women's and children's services for the St. Luke's-Shawnee Mission Health System in Kansas City, MO. Start by implementing several security measures:
· Make the parent(s) part of the security team.
"The most important facet of security is education," says George Stevens, associate director of the department of standards of the Joint Commission. "You can put in place all the engineering controls you want and all the physical barriers you want, but if the mother hasn't been educated about the dangers of passing her infant to an unauthorized person, all systems will fail." Equally important, he says, is teaching the mother how to recognize her own baby.
Beginning in birthing classes, staff should educate parents about dangers and security precautions. Ropp says St. Luke's has had a good history so far in this area. "We have an educational thread that begins in our prenatal classes. We tell parents that they are key to the process of protecting their babies, not just in the hospital but afterward as well." St. Luke's provides all families with notebooks that contain information they should know, including the fact that they should feel free to question anybody, anyplace, at any time - physicians, nurses, and hospital administration - about hospital practices.
Remind parents about security issues discussed in birthing classes. Signs can be worded as though the baby were talking: "Mommy, make sure I'm who you think I am. Check my ID."
"We convey to them the importance of getting to know their newborns," says Ropp. "To accomplish that, I personally am in favor of rooming in. It's not universally popular, but the first couple of days are critical for mothers and new babies. We encourage minimizing the separation time." In addition, when the baby is delivered, he or she stays in the birthing room with the mom as long as possible.
St Luke's comprises seven area hospitals, where 7,000 babies are born each year. "We have a steady stream of families who call us in advance and ask us about our security procedures," says Ropp.
"We tell our mothers to go through the whole identification process step by step each time they pick up their babies at the nursery. Babies look a little different on the day after they are born because of weight loss and a slightly different coloration," points out Ropp. Moms are instructed to make sure the date and time of birth match. "Every time we and they don't do the whole procedure, we're at risk," she says.
Parents and visitors are instructed not to carry babies in the hallways but to always use bassinets. That way, if someone is seen carrying a baby, it is an alert to staff that he or she may not be authorized. Nursing staff have special color-coded badges with photographs and names, and incoming parents are told never to give their baby to someone who doesn't have a badge.
To further encourage moms to get to know their babies, Ropp says, St. Luke's has obtained a corporate sponsorship from the Kansas City Royals professional baseball team. "The Royals have provided us with newborn T-shirts. We encourage parents to dress their babies in that T-shirt when they take them home. That way they, not the nurse, dress the baby, and it's one last chance to give a final inspection of birthmarks or other features."
· Use a bracelet identification system.
Most hospitals routinely use triple or quadruple bracelets to ensure that mother and baby are not separated. A delivery room nurse marks each bracelet with the mother's name, medical record number, baby's gender, time of birth, and name of physician. She should place one identifying bracelet on the mother and two on each infant, generally arm and leg. The father, significant other, or another family member also should wear a wrist band authorizing that person to come to the nursery, pick up the baby, and bring the baby back to the mom's room. Each time a staff member gives a baby to the parent or visitor, he or she should match bands to ensure the numbers are identical.
"The first thing we do is put the identification bracelets on mom, baby, and significant other - if not the father, maybe a grandma or sister," says Ropp. "We don't yield babies unless they are identified."
Check bands for slippage
Make sure bands don't slip off the baby, as may have happened in the Virginia case. Newborns lose about 10% of their birth weight; their wrists and ankles are chubby at first, then get slimmer. "For that reason, our nurses apply the bands rather snugly," says Ropp. "The mother should be told the importance of checking for slippage." Anytime anyone unwraps the baby, those brace lets and the cards on the cribs should be checked.
Bands are at special risk of being dislocated during NICU hospitalization due to edema and the presence of IVs. It is essential that a clear policy and procedure on rebanding be in place in that unit.
· Record an accurate description of the infant in the medical record.
Properly identify characteristic traits such as birthmarks. Include in the record a photograph of the baby's face, a footprint, and a fingerprint of the mother's right index finger.
· Limit access to the nursery and maternity floors.
Those patient areas should be limited to staff who have a need to be in the area and bracelet wearers, and signage should indicate that. Keep to a minimum the number of entrances, and place security cameras above each exit. The cameras should not only produce a record, but relay a picture to monitoring screens at the nursing station and the hospital security department.
· Install electronic surveillance.
Employ an electronic card access system. All doors to all nurseries should be equipped with self-closing hardware and be locked at all times.
St. Luke's uses an electronic system that defines a perimeter around the unit, and the babies wear a hidden device that sounds an alarm if they are carried through the barrier. The alarm is audible throughout the patient care unit and automatically locks all the stairwells, exits, and elevators from the unit. When staff hear that alarm, they stop whatever they are doing and make sure they can account for every baby. The alarm also alerts the security department and a representative comes within 20 to 30 seconds.
Some systems are simple, some complex. One that utilizes an electronic activator designed to cover five exits costs about $25,000 - a one-time cost. Once installed, it's best not to publicize where electronic activators are hidden because it would serve as advice to a potential switcher or abductor.
"[Our facility] does not have an electronic security system," says Marcia Patterson, RN, director of obstetric services at Rush-Presbyterian-St. Luke's Medical Center in Chicago. "Vendors have come to talk to us about installing one, but we haven't seen the value. I know that some systems attach a sensor to the umbilical clamp. We feel that the best defense is alert personnel who give good instruction to parents."
· Develop an emergency plan to be activated when an infant is noted missing.
The plan should call for posting personnel at each exit and notifying the local police. Perform unannounced practice drills to discover and address weak points. "Our facility's plan puts the department on alert for anyone leaving the building unaccompanied by a staff person with a baby or suspicious parcel," says Ropp. The system does give a false alarm periodically when someone accidentally throws a device in the trash, but that serves as a drill. "Regular drills are called Code Pinks. Once we're certain every baby is accounted for, we go back to business as usual."
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