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Preventing Infant Abductions: An Infant Security Program Transitioned Into an Interdisciplinary Model

Hiner, Jacqueline MSN/Ed, RNC-OB; Pyka, Jeanine MSN, RNC-MNN; Burks, Colleen RNC-OB, C-EFM; Pisegna, Lily MBAH, BSN, RNC, NE-BC; Gador, Rachel Ann RN

The Journal of Perinatal & Neonatal Nursing: January/March 2012 - Volume 26 - Issue 1 - p 47–56
doi: 10.1097/JPN.0b013e31824003a2

Ensuring the safety of infants born in a hospital is a top priority and, therefore, requires a solid infant security plan. Using an interdisciplinary approach and a systematic change process, nursing leadership in collaboration with clinical nurses and security personnel analyzed the infant security program at this community hospital to identify vulnerabilities. By establishing an interdisciplinary approach to infant security, participants were able to unravel a complicated concept, systematically analyze the gaps, and agree to a plan of action. This resulted in improved communication and clarification of roles between the nursing and security divisions. Supply costs decreased by 17.4% after the first year of implementation. Most importantly, this project enhanced and strengthened the existing infant abduction prevention measures, hard wired the importance of infant security, and minimized vulnerabilities.

Labor and Delivery (Mss Hiner, Burks, and Gador), Women's Surgical Services (Ms Hiner), Obstetrics and Gynecology, Lactation and Parent Education (Ms Pyka), and Women's and Children's Services (Ms Pisegna), Sharp Grossmont Hospital, La Mesa, California.

Corresponding Author: Jacqueline Hiner, MSN/Ed, RNC-OB, Labor and Delivery and Women's Surgical Services, Sharp Grossmont Hospital, 5555 Grossmont Center Dr, La Mesa, CA 91942 (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: July 28, 2011; Accepted for publication: November 2, 2011

To ensure the safety and security of infants born in a hospital, a solid infant security plan and process are required. Although infant abductions are not common, they can be devastating for family members, the staff, and hospital. All disciplines that play a role in infant security must know and understand how critical their roles are in preventing an infant abduction. Infant security can be multifaceted involving the physical layout of the hospital, various unit personnel, policies and procedures, and security equipment. How does a birthing facility bring all of these layers together to form a solid foundation for infant safety and security?

Because of the volume of women and infants cared for in this birthing facility and the number of births each year, the nursing administration team chose to examine its infant security program based on infant electronic security device audits. In doing so, vulnerabilities were identified. Despite the presence of infant security policies and an electronic infant security system (HUGS Infant Protection System, Stanley HealthCare Solutions, Lincoln, Nebraska), there were breakdowns in the infant security process leading to potential risks of infant abduction. In addition, an analysis of retrospective data revealed operational cost of greater than $5000 per year as a result of lost and/or missing infant electronic security devices. The purpose of this article is to provide an overview of the evaluation of an already existing infant security program, the change process, and the interdisciplinary plan of action implemented to improve infant security as processed by 1 institution.

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According to the National Center for Missing and Exploited Children (NCMEC)1 between 1983 and 2011, 128 infants have been abducted from a healthcare facility in the United States, with 5 infants still missing. Of those infants, 74 were taken from the mother's room, 17 were abducted from a nursery, 17 from the pediatrics unit, and 20 infants were abducted on the premises of the healthcare facility.1 California and Texas lead the nation with the highest infant abduction rate from a hospital with 15 abductions each.1 The NCMEC has continued to analyze infant abduction cases and has provided recommendations on how hospitals can implement an infant security program to protect infants.

Along with the NCMEC, regulatory agencies have determined infant abduction to be a serious patient safety concern. In 2002, the term “Never Event” was introduced by the National Quality Forum in order to identify medical errors that were viewed to have serious consequences despite being clearly preventable.2 The Never Event was initially defined as 27 separate events but increased to 28 events in 2006. The list of preventable Never Events included abduction of a patient at any age and discharging an infant to the wrong person. In May 2006, the Centers for Medicare & Medicaid Services notified healthcare organizations that they would receive reduced payments for care when a Never 28 Event occurred. Hospitals were also required to create an environment where Never Events are dealt with appropriately.3 In addition, healthcare organizations have a responsibility to report the Never Event to The Joint Commission and the state department of public health.4 A root cause analysis should be performed to identify why the event occurred and what processes can be implemented to prevent the Never 28 Event from recurring. The Joint Commission4 considers an infant abduction as a sentinel event and recommends that healthcare organizations perform an annual proactive risk assessment of a high-risk process. In light of this, this hospital chose to evaluate its infant security program.

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The literature on infant safety and security has focused on trending and analyzing infant abductions that have occurred in the hospital setting.58 On the basis of analysis of infant abduction case reports, the NCMEC has published recommendations to assist birthing facilities in establishing protocols and emergency response plans to prevent infant abductions.1 Conducting a needs assessment of the facility is recommended in order to develop a comprehensive infant security program. Educating hospital staff on the characteristics of a typical infant abductor and strategies employed by abductors to evade hospital security systems is important to heighten awareness for staff members. It is also necessary to educate parents on how to prevent an infant abduction.

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Needs assessment

An infant security program must be tailored to the facilities; therefore, a needs assessment should be conducted to determine the extent of the infant security system required.9 Different areas of the hospital and personnel must be taken into account during the needs assessment. Understanding the gaps within the physical layout of the hospital is imperative in order to decrease vulnerabilities. For example, the amount of available exits within the building, unmonitored stairwells, and accessibility of the neonatal areas to the public must be examined.9 Once the assessment is completed, security personnel and hospital administration must develop an infant security program that will decrease vulnerabilities and promote patient safety. This plan should include educating staff on characteristics of a typical abductor and strategies used during an infant abduction.

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Characteristics of a typical abductor

The profile of a typical infant abductor has been developed on the basis of characteristics and behaviors demonstrated by previous abductors to assist healthcare personnel and law enforcement agencies in identifying potential abductors.1 It is essential that all personnel working in a birthing facility know these characteristics. After examining abduction cases, it was noted that females comprise 96% of abductors ranging from 14 to 53 years of age .1,68 In 75% of the cases, abductors had made prior visits to the site of abduction and 45% of the abductors impersonated a healthcare worker.7 Personnel working in a birthing facility must be hypervigilant of all visitors entering the facility. Establishing visitation guidelines such as requiring all visitors to wear a specific badge when visiting a patient within the facility may assist in identifying a possible abductor.10,11 In addition to visitor's guidelines, staff members who are allowed to interact with infants should have a specific identifier such as a special identification tag or color-coded uniforms.6,8 In addition to staff education, making parents aware of hospital safety procedures is crucial in the prevention of an infant abduction.

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Parent education

Parent education is the most critical intervention nursing staff can initiate to prevent an infant abduction.5,6,8,11 Education must begin at the time of admission to the birthing facility and should be enforced throughout the hospital stay. Nurses should instruct parents on the facility's visitation guidelines; safety procedures in place to protect infants; how to identify hospital staff who are allowed to interact with infants; never to leave the infant unattended; and, most importantly, what to do if a stranger requests to see the infant or remove the infant from the room.6,8,11 During a change of shift, it is important for the nurse caring for the mother and the infant to introduce the next nurse who will take care of the couplet during the shift to decrease the risk of abduction.

The literature is clear on prevention strategies that should be incorporated into any infant security program to assist in decreasing the risk of an infant abduction. Infant security does not involve only 1 element but various layers of the hospital system. A strong and comprehensive infant security program can be developed or enhanced by incorporating a needs assessment of the facility and conducting staff and parent education to prevent infant abductions.

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This hospital is the largest healthcare facility in East San Diego County with 536 licensed beds and offers a wide range of services. The hospital received its initial American Nurses Credentialing Center Magnet Recognition in 2006 and was recently redesignated in 2011. This multihospital system also received the Malcolm Baldrige National Quality Award in 2007. This hospital performs approximately 3700 infant births per year, performs 1200 inpatient and outpatient gynecologic surgeries, and offers comprehensive obstetric, gynecologic, and level 3A neonatal intensive care services (neonatal intensive care unit [NICU]) as defined by the American Academy of Pediatrics.12 The Women's Health Center (WHC) has approximately 300 staff members and is a separate building from the main hospital, which provides some security challenges with its open layout to accommodate a family-centered environment. The WHC has an electronic infant security system, infant security policies and procedures, and an emergency response plan. Despite these elements already in place, enhancements needed to be made to the security program.

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Infant security system

The existing electronic infant security system was present in the labor and delivery and postpartum units. Computer monitors containing the layout of the units and activated electronic security devices are found in the nursing stations of both units. The electronic security devices have identification numbers associated with the device and were housed in both units. During the admission process of a newborn, the electronic security device was placed on the infant's ankle using an ankle bracelet to hold the device in place. Once the device was in contact with the infant's skin, an automatic registration of the electronic device number occurred in the computer system. This registration allowed the electronic security system to track the device via radio transmission. The admitting nurse had to manually input the infant's name and room number in order to match the infant with the electronic device number. If this step was omitted, it would be very difficult to quickly identify which device number belonged to which infant.

The security system has built-in sensors at major exit areas to detect when an electronic security device is removed from the building. When an alarm is triggered, the infant security computer terminals located in the nursing units transmit this alarm to alert nursing staff. The terminal will display the geographical location of the electronic security device where it was last detected. Once the source of the alarm is investigated, the alarm may be silenced or if it is truly an infant abduction, the emergency response plan will be activated.

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Emergency response plan

The emergency response plan to an infant abduction in this facility is called a “Code Purple.” This code is called by the unit that has identified that an infant is missing or has been abducted from the hospital, or there is knowledge or suspicion that an unauthorized individual is attempting to leave the facility with an infant. In addition to the unit calling the Code Purple, a page is announced by the hospital operator to initiate a coordinated response by hospital staff members to monitor all exits according to the hospital policy and procedure. Code Purple drills are conducted monthly and each shift must be drilled at least twice per year. The purpose of the Code Purple drills is to evaluate the staff's and security personnel's responses according to the emergency response plan (Table 1). After each drill, the purpose, synopsis, summary, and action plan are written up by the security manager. Any action items or follow-up is shared with the WHC leadership team and disseminated to staff members.

Table 1

Table 1

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In order for successful patient outcomes to be achieved, multiple disciplines must work together to attain those outcomes. The concept of interdisciplinary collaboration is not new in healthcare and it has been shown that it is an important factor in decreasing errors and clarifying roles and responsibilities.13 According to Petri,14 interdisciplinary collaboration is problem-focused and is often used to solve challenges in the patient-care arena. Developing an interdisciplinary team is a process in which the participants are encouraged to share their knowledge, challenges, and contributions to the healthcare team and in turn establish a sense of trust and respect for each other.15 In addition, participants should have equal power in the decision-making process to enhance commitment to the project and accountability for the outcomes.14

The evaluation of infant security program is multifaceted; therefore, it was essential that an interdisciplinary team be brought together to identify, analyze, and develop a solution for improving the infant security program. Nurse managers, security management, nurse educators, clinical nurse specialists, clinical lead nurses, charge nurses, and security officers comprised this team, which met on a monthly basis. The members of the task force were chosen on the basis of their roles on the units and shifts worked to ensure that personnel from both the day shift and night shift were represented. The director of the WHC and the chief nursing officer of the hospital were the project sponsors. Because of the complexity of this project, an official change agent was asked to assist in facilitating the process. The change agent is a member of the hospital administration team and completed formal education on process improvement strategies through the Six Sigma program.

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Six Sigma improvement process

By definition, Six Sigma is a statistical term used to represent near-perfect levels of performance.16 The goal of Six Sigma is to decrease process variations and achieve near-perfect results by using a disciplined, systematic, and data-driven approach that is tailored to the customer's needs and goals to improve financial and operational performance.16 The Six Sigma program was first implemented by Bill Smith when working for Motorola as a senior engineer. The company's goal was to increase profits by reducing defects.16 By using the Six Sigma program, Motorola was able to streamline its processes, considerably increase its profits, and was recognized worldwide with many prestigious awards. Many different organizations have adopted the Six Sigma program to improve and measure performance within their companies.

During the infant security Six Sigma process improvement meetings, disciplined strategies were employed to uncover issues in the infant security program. The first tool used was Workout, which is a problem-solving and decision-making session involving the practitioners who carry out the work.16 It was necessary that the clinical nurses, charge nurses, and security officers were involved in this process to identify the daily challenges they encountered with the infant security program. The brainstorming activities during the Workout assisted in identifying many of the pitfalls of the current infant security system.

Once the gaps were identified, a failure mode effect analysis (FMEA) was used to prioritize which area to correct first. An FMEA determined the list of potential failures, effects of the failures, potential causes, occurrences of each failure, and severity.17 Each area was scored on a scale of 1 to 10 (1 being least often, 10 being very often). In order to determine which failures posed the highest risk to the families and the organization, a mathematical calculation (severity × occurrence × detection) was used to determine the Risk Priority Score (Table 2). The results of the Risk Priority Score lead to the top priorities and causes of the vulnerabilities.

Table 2

Table 2

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Multiple vulnerabilities were identified, which involved the physical layout of the security system, staff's response to alarms, knowledge deficits among security and nursing staff, omission during the admission and discharge process, and a lack of a solid inventory process to reconcile the electronic security devices.

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Complacency with alarms

The top priorities identified included staff complacency with alarms and the accessibility to the electronic infant security system by personnel. Alarms were intrinsic to the system. There were an increased number of alarms encountered because of errors in applying the bands, lack of parent education related to the purpose and use of the electronic security devices, and the failure of nurses to appropriately suspend the device before the infant left the unit for a procedure. As a result, there were a number of “false” alarms that would occur on a daily basis. The intent of an alarm is to warn staff of a potentially negative occurrence from becoming completely out of control18; however, nurses and security officers became desensitized to the alarms and perceived the alarms as nuisances.

The staff's complacent attitude attributed to the lack of response to alarms. According to McKinnon,18 infant abductors have been successful in evading the infant security system because of delayed responses by staff to alarms. It was critical that nursing staff and security personnel understood their roles and what actions to take when an alarm was activated. It was equally important for staff to inform parents where alarm boundaries were set within the unit and to educate them that the electronic infant security device should not be removed from the infant until discharged from the hospital.

All staff members in the WHC including nurses, unit clerks, nursing assistants, and security personnel had the ability to access the electronic infant security system. Personnel were silencing the alarms to eliminate the noise before investigating the cause of the alarm and status of the infant. These actions posed a large threat to families and the organization.

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Admission process

The electronic security system is only a tool to assist in preventing an infant abduction. If the users are not using the product correctly, the system is not guaranteed to work. This concept was illustrated during the admission process of infants. After the birth of the infant, the electronic security device is applied to the infant's ankle by the delivery nurse. It was the responsibility of the delivery nurse to input the name of the infant and the room number to match the infant with the electronic security device number. Nurses were failing to identify the infant in the electronic security system. If an alarm were activated on an unidentified device, precious time would be lost in identifying which infant was attached to that device. It was important that nursing be responsible for inputting the necessary information into the computerized security system.

During the Workout, it was also noted that 2 areas were not equipped with the infant security system. Infants born via cesarean birth and then cared for in the transition nursery did not have an electronic infant security device applied until after the infant was transferred to the postpartum unit. At that time, the transition nursery did not have the security system installed. These infants were extremely vulnerable to abduction as the transition nursery was accessible to the public. The NICU was not equipped with the electronic infant security system. Although the NICU is a locked unit, there was still potential for an infant abduction from this area.

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Discharge process

In addition to the gaps identified during the admission process, multiple vulnerabilities were detected during the discharge process. Prior to discharge, 2 postpartum nurses would verify and remove the electronic security device from the infant in the patient's room. It was not uncommon for an electronic infant security device to be removed from an infant 30 to 60 minutes prior to discharge. Infants were vulnerable to abduction during this period, especially when various staff such as nursing staff, nursing assistants, volunteers, and nursing students accompanied the mother and infant out of the WHC.

While analyzing the discharge process, it was discovered that security devices were frequently missing or lost. Nurses would place the security devices in their pockets and forget that they had them. Some devices would fall off of the infant's ankle because the infants lost weight or the electronic infant security device was placed too loosely. It was not uncommon for electronic infant security devices to fall off of the infant and then inadvertently be thrown in with the linens or discarded by environmental services during the cleaning of vacant rooms.

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Knowledge deficit

Another issue that was identified during the Six Sigma meetings was that security personnel had a lack of understanding about the electronic infant security program. The security officers were trained on what to do and who to call during an infant abduction but did not have an active role in the infant security program. After learning that the electronic devices were being removed too early, the security officers were very interested and eager to become involved in the discharge process. Their goal was to ensure that the WHC was as secure as possible.

During the Six Sigma meetings, using the FMEA tool, it was noted that there was confusion within the WHC staff as to what locations each designated department was to monitor. Although a map of the purple dots designating each department's responsibility for monitoring during an abduction or drill had been developed, it was not easily accessible to the staff. In addition, the task force recognized that there were specific exits that were not taken into consideration and left unmonitored during an infant abduction or drill.

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Financial analysis and inventory process

Decreasing the cost became an added focus of this project because the electronic infant security devices were constantly being replaced because of loss. A financial analysis determined that in 2007, there was a loss of approximately $5000 in lost electronic security devices. Electronic device costs consist of the electronic device at approximately $109 per device as well as the cost of bands that encircle the infant's ankle. Replacement costs vary on the basis of different factors.

The excessive expenditure for the electronic security devices was attributed to the lack of a solid inventory process. Electronic security devices were kept in both the labor and delivery and the postpartum units in a device holder. The nurses would obtain the electronic security devices from this area when preparing for a delivery or an infant transfer from the NICU. The electronic security devices would also be returned to this location upon discharge of the infant. Many of the electronic security devices were not returned to their respective holders because of the reasons discussed earlier. The electronic security devices were counted by the charge nurse on the postpartum unit at the end of each shift and by administrative personnel on a weekly basis. There was no reconciliation process. Without knowing which electronic security devices were in circulation, it was impossible to track which security devices were missing and why.

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After identifying the gaps and vulnerabilities, new workflow changes needed to be designed and implemented. The interdisciplinary team set a “Go Live” date of March 2009 to implement the new change process. To meet this deadline, top priorities involved educating the WHC staff to include nursing personnel, security personnel, environmental services staff, volunteers, and parents about the infant security program. In January 2009, all WHC staff and anyone assigned to the WHC underwent mandatory education using a 1-hour computerized self-learning module detailing their roles and responsibilities in the infant security program. The self-learning module outlined the characteristics of an infant abductor according to the recommendations of the NCMEC, the actions staff members should take when an electronic infant security device triggers an alarm as stated in the facility's policy, and the appropriate steps to be taken during a suspected abduction.

Nurses were educated to inform the parents at delivery to refrain from adjusting the electronic security device or pulling on the band, which resulted in fewer tamper alarms. Also, to ensure that the correct electronic security devices were placed on the infants, nurses were instructed to double-check the security device number with another nurse whenever care was assumed by another nurse to decrease the number of unidentified infants. Most specifically, environmental services staff members were educated not to throw away electronic security devices if one was left in a patient room and the importance of returning the electronic security device to the nursing station. All personnel working in the WHC were reeducated on being extraobservant of visitors on the unit and to ensure that all visitors were wearing visitor badges. The education reemphasized that the electronic infant security system is just a tool in the infant security program and ultimately infant security is everyone's responsibility.

Another key element was the inclusion and education of the security team. With the new process, it was decided that the security officers would play a much more active role in infant security. The role and responsibilities of the security officer in the WHC were changed completely and required more training. Therefore, security personnel were trained on the use of the computerized infant security system. One security officer was trained in the new discharge process and a “train the trainer” approach was used to train all security personnel who worked in the WHC to identify the correct infant and electronic security device number before discharge. A log is also maintained to document the discharged infants and electronic security devices.

The security officers watch the major entrance and exit to the WHC and are actively involved in locating alarms by calling the nursing units when an alarm is triggered. More security cameras were installed to provide security officers with direct visualization of each unit, all entrances, and exits.

Previously, the nurse would disable the security device on the nursing unit prior to discharge. With the change process, the security officers in the WHC collaborate with the nurses and are now integral players in discharging the electronic security devices in the system. All mothers and infants must stop at the security desk to allow the security officer and nurse or nurse's aide to double-check the infant's name and security device number. Once identity is confirmed, the security officer deactivates (discharges) the infant's electronic security device out of the computer system and the device is removed by the nurse or the nurse's aide. The mother and the infant are then accompanied out of the building as they are officially discharged. This modification in workflow enhanced the ability of the electronic security system to continue to monitor the location of the infant up until the time the mother and the infant have been discharged from the WHC. The security officers were also provided with access to the hospital's electronic patient tracking system to assist in accurately locating patients throughout the WHC and directing family members accordingly.

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Response to infant security alarms

Although the security officers had access to the electronic security device, the process of silencing alarms was altered. For an alarm to be silenced, a new standard was developed throughout the WHC. The responsibility of silencing of alarms was placed on the registered nurses of the unit in which the alarm originated. The nurses are able to silence the alarm only after the cause of the alarm has been identified and the safety of the infant has been determined. Security officers, unit clerks, or nurse's aides are not allowed to silence alarms; however, the security officer has a new role including locating the alarm and calling the involved unit to verify that the infant is in the room and is safe.

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Expanding the infant security system

At the time of implementation, the transition nursery and the NICU did not have the electronic security system installed. The NCMEC recommends that infants in the nursery or the NICU be consistently observed at all times to prevent abduction. Therefore, in May 2010, the electronic infant security system was purchased and installed in the transitional care nursery to protect the infants located in this area. The changes were implemented in the transition nursery first since this was identified as a vulnerable area during the FMEA assessment, because this area was more accessible to the public than the NICU was.

Although the NICU is a locked unit, in April 2011, the infant security system was installed in the NICU. Mandatory education involved training all NICU nurses on the use of the infant security system as well as the criteria for which infants would have an electronic security device placed on them. All infants admitted to the NICU have an electronic security device in place unless critically premature or unstable, who require invasive line placement and monitoring equipment.

Another enhancement was made to the infant security program in November of 2010. BabySense (Stanley HealthCare Solutions, Lincoln, Nebraska) was purchased and implemented as an upgraded feature to the electronic security system. This technology notifies nurses when the electronic security device is not in contact with the infant's skin for longer than 60 seconds. The purpose of incorporating the BabySense feature is to alert the nurse to check the tightness of the strap to ensure that the electronic security device is in place.

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Inventory process

As stated earlier, prior to the implementation of this new process, the WHC did not have an effective inventory process. To improve the inventory process, infant electronic security devices are now reconciled at the end of each shift by security and nursing personnel. The labor and delivery charge nurse generates a discharge report from the computerized security system and this report is compared with the security officer's discharge log for each shift. If a discrepancy is identified, the charge nurses and the security officer on duty call each unit and do an investigation to locate the missing electronic security device. Two central storage boxes were created in the WHC. One box is located at the security desk and the other box is located on the labor and delivery unit. Each unit also has a wall device to store unused electronic security devices. This assists the team in locating any missing devices at the end of the shift.

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In April 2009, the hospital's policy and procedure detailing nursing and security personnel's responsibilities was changed to incorporate the new change process. In January 2010, the Code Purple policy was updated to include newly designated locations for staff to respond to in the event a Code Purple was called.

Communication between the security department and the WHC administration team has increased through monthly WHC security meetings. The hospital's security manager and WHC managers meet to review electronic security device audits. This information is disseminated to the staff to continue to reinforce the importance of entering the appropriate information into the electronic security system.

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Audit results

Since the comprehensive education was implemented to all WHC staff, biweekly audits have shown consistent documentation of infant information in the electronic security system. Prior to implementation, an average of 2 infants per month was not identified in the electronic security system. Audits conducted March 2009 through July 2011 demonstrated a total of less than 1 infant per month that had not been identified in the electronic security system.

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Inventory process and cost analysis

An inventory log is maintained in the WHC administration office to monitor and track the electronic security devices that are sent out for repair or replacement due to warranty expiration or loss. This log has allowed administration to diligently track financial data. This log assisted in calculating a detailed cost analysis.

The cost analysis was based on the total electronic device cost for the baseline year 2008. The electronic device and the bracelets make up the total cost per unit of service (UOS). To calculate the cost per UOS, live births were used. The NICU admissions were subtracted from the number of infants with electronic security devices in place. The total device cost of the infant security devices was then divided by the number of infants with electronic security devices in place to provide an accurate determination of the cost per UOS (Table 3).

Table 3

Table 3

In 2008, it was determined that the total device cost was $17 900. The facility had 3766 live births subtracted by the NICU infant admission, which resulted in a total of 3355 infants with electronic security devices in place at a baseline cost of $5.34 per infant. In 2009, $14 538.00 was spent in device cost. The cost per UOS decreased from $5.34 to $4.55, rendering a 17.14% savings in total supply cost. In 2010, $13 962 was spent, based on 3197 infants with electronic security devices placed, at a cost of $4.37 for a further 4.29% decrease in overall supply costs. In 2011, $14 690 was spent in total device cost with 3508 total live births. As of April 2011, NICU began applying electronic security devices to infants meeting criteria. A total of 186 NICU infants had an electronic security device in place. Factoring in the total live births with the NICU infants, a total of 3291 infants had electronic security devices applied at a cost of $4.46 per UOS. When one compares the total cost per UOS for each consecutive year after implementation (2009, 2010, and 2011), the facility experienced a savings in total supply costs of 17.14%, 22.17%, and 19.53% compared with the baseline year.

To calculate and compare costs across the years, cost adjustments had to be factored in because of a cost increase of the electronic security devices from $109 to $119 between 2009 and 2011. The bands also increased in cost between 2009 and 2011; therefore, in order to make accurate calculation of the true cost per UOS, adjustments had to be made. Despite the electronic security system implementation in the NICU, the cost of electronic security devices was contained and increased the total costs per UOS only by 2%.

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Although the overall outcome has been very successful and something this community hospital is proud of, there were some obstacles and lessons learned. A key component to the success of this program was teaching nurses the importance of investigating the cause of an alarm before silencing an alarm. During the first few months after implementation, continual reinforcement by the charge nurses and management team was made to ensure that all members of the interdisciplinary team were doing their part in infant security. The charge nurses reminded the staff not to ignore ringing alarms, not to decrease the volume on the electronic alarm system, and reinforce the importance of entering the infant's information into the electronic security system.

Perhaps the largest obstacle was getting the security department and some individual officers to embrace and adopt their new responsibilities. Some of the initial vulnerabilities identified during WHC security meetings included the following: security officers not using their own codes to discharge the infants, security officers discharging the wrong electronic security device in the computer system, incorrect or incomplete information recorded on the discharge log, and the inability to properly reconcile the security devices each shift. With further education, all of the aforementioned gaps were quickly remedied. Enthusiasm from some in the department was not high but with education and new expectations, the majority of the officers have accepted the change and are now fully engaged in the infant security process. Those security officers who did not feel confident in the process were reassigned to other areas of the hospital.

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Infant security is an evolving process and with continued audits and each infant abduction drill, security officers and nurses continue to learn how to enhance and improve the infant security program. By employing an interdisciplinary approach to evaluate and improve the infant security program, both the security and nursing divisions were able to understand each other's roles, responsibilities, and challenges in revamping this program. Mutual respect was developed for both departments and the accountability for success of this program was shared. Ultimately, each staff member must remember how vital his or her role is in keeping our youngest and most vulnerable patients safe.

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abduction; electronic security system; infant security; interdisciplinary; process improvement

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