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Preventing infant abduction in the hospital

Miller, Randy S. RN, C, BS, MSN

doi: 10.1097/01.NURSE.0000291964.38539.29
Department: upFront: PATIENT SAFETY

Preventing infant abduction

Randy S. Miller has a background in maternal-newborn nursing. Currently she's student coordinator at Orlando (Fla.) Regional Healthcare and an adjunct instructor in the College of Nursing at the University of Central Florida, also in Orlando.

A WOMAN DISGUISED in scrubs walked out of a hospital in Texas with a baby hidden in her purse last March. Fortunately, police found the infant and returned her to her parents the next day. Such infant abductions from hospitals are rare (accounting for only 0.5% of all sentinel events reported to The Joint Commission1), so you may never be involved in this kind of incident. Even so, 116 infants were abducted from hospitals between 1983 and 2004,2 so staff members in any facility caring for infants must be aware of the threat.

The good news is that most infant abductions are avoidable. In this article, I'll tell you how infant abductions can be prevented when facilities institute best-practice guidelines, teach staff about patient-safety protocols, and educate infants' families.

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Plan for safety

If you work in a unit that has infants, see Keeping infants safe for critical guidelines to follow, then assess your unit's procedures. Are best-practice guidelines in place and are they being followed? If not, talk with your nurse-manager about how to incorporate them.

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Arousing suspicions

Staff should learn to be suspicious of anyone who visits the unit repeatedly but isn't visiting a specific patient. A potential abductor may study the unit layout, learn when staff goes into patient rooms, and ask questions about feeding times or nursery location. Anyone carrying an infant in her arms (rather than in a bassinet) or carrying large bags or packages should raise a red flag.

The abductor may target a patient room that's far away from the nurses' station or that's near an exit, stairway, or elevator. She may also create a diversion (or have an accomplice create one) so that she can escape unnoticed with the infant.

If you suspect that an infant has been abducted, activate your unit's infant alarm system immediately. This should lock all exits from the unit while security personnel search the building and the grounds. If your unit doesn't have an infant alarm system, contact security immediately to secure the perimeter of the building and to send staff to monitor all unit exit doors until security gets to the unit.

Local police may be called in as well. Go to your assigned post and wait for further instructions. At least one nurse should remain with the parents. Call a social worker or a chaplain to help support the parents if needed.

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Ongoing education

Infant safety should be incorporated into annual staff competency assessments, and mock infant abduction drills should be part of staff education. These drills should be repeated as many times as needed to ensure that you and other staff members are comfortable and competent in your roles during an infant abduction.

During orientation, teach each new staff member how to recognize suspicious individuals. Review your facility's policies and procedures with her and make sure she knows what to do if she suspects that an infant is being abducted. Provide written instructions about how to activate the alarm system and call security. She must also know the policy and procedure for informing the infant's family about a possible abduction.

Educating staff is only part of the equation. When the mother or infant is admitted, explain to the parents the unit and hospital safety measures.

For instance, the parents need to know that if they want to walk with their infant, he should be in the bassinet and not in a parent's arms. The infant's security band must remain attached to his wrist and ankle at all times.3 Tell parents to call a nurse right away if the baby's band comes off. The nurse should replace it immediately in the presence of both parents, if possible.

Make sure the parents know your name and the names of other unit staff who might take the baby to the nursery or to another department for tests. Familiarize them with unit ID badges. Encourage them to ask to see identification of anyone who comes to look at the baby or take the baby to the nursery. If at any time a parent feels uncomfortable with someone who's in the room, she should press the call bell to summon a staff member.

Write down the unit routine on a whiteboard in the patient's room. When the parents know the unit's routines, they're more likely to notice when something isn't right.

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Prevention is best

By educating nurses, staff, and parents, and practicing what you've learned, in most cases, you can help prevent an infant abduction before it happens.

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Keeping infants safe

The Joint Commission has established best-practice guidelines for preventing infant abduction in the hospital, including these steps:

  • Attach secure identically numbered bands to the infant (wrist and ankle bands), mother, and father or significant other immediately after birth.
  • Footprint the infant, take a color photograph of him, and record his physical examination within 2 hours of birth.
  • Implement an infant security tag or abduction alarm system, such as a bar-coding system or umbilical clamp, which triggers an alarm, locks doors, and freezes elevators if the infant comes within 4 feet of an exit or elevator.
  • Transport infants only in bassinets; don't allow them to be carried or left in the hallway without direct supervision.
  • Establish a tracking system to document where the infant is at all times.
  • Require staff to wear up-to-date conspicuous, color-photograph ID badges and require staff in direct contact with infants to wear a second form of unique ID, such as a badge with a pink background.
  • Don't publish birth announcements in local newspapers. Don't post the full names of mothers or infants where other patients or visitors can see them.
  • Control access to the maternity unit; for instance, keep all unit exit doors locked and make sure they're monitored by video surveillance cameras with a date/time stamp.

Source: The Joint Commission, 2003.3

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REFERENCES

1. The Joint Commission. Sentinel event statistics.. Accessed April 26, 2007.
2. Rabun JB Jr. For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions, 8th edition. National Center for Missing and Exploited Children, 2005.
3. The Joint Commission. Root causes: Practical approaches for preventing infant abduction. Joint Commission Perspectives on Patient Safety. 3(10):7–8, October 2003..
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RESOURCE

Howard BJ, et al. The pediatrician's role in the prevention of missing children. Pediatrics. 114(4):1100–1105, October 2004.
© 2007 Lippincott Williams & Wilkins, Inc.