Code pink

Protecting our tiniest patients

Q: A nurse working the night shift on a maternity unit notices an unauthorized person walking toward the exit door holding an infant in her arms. The nurse feels compelled to protect the baby but, at the same time, she's conflicted over her own safety and that of the other patients in her care. What should this nurse do?

A: The nurse should call a code pink. When a code pink is called, it indicates an infant abduction is taking place in the hospital. Used by most hospitals in the United States, it's used to protect infants from removal by unauthorized persons and identify the physical description and actions demonstrated by someone attempting to kidnap an infant from a healthcare facility. Since 2008, more than half of the 252 infants abducted nationwide were taken from healthcare facilities. This crime is of particular concern to maternity and pediatric unit nurses who are on the frontline of preventing infant abduction. Maintaining preparedness for a code pink is an ongoing challenge and it's every nurse's responsibility to be vigilant in this effort.

According to the National Center for Missing and Exploited Children, the typical abductor is:

• female
• between ages 12 and 50
• overweight
• compulsive
• frequently indicates that she has lost a baby or is unable to have a baby
• usually lives in the community where the abduction has taken place
• makes frequent visits to the pediatric or nursery unit before the abduction
• frequently impersonates a nurse or other allied healthcare professional
• usually plans the abduction
• becomes familiar with healthcare staff, work routines, and the infant's parents
• demonstrates a capability to provide good care to the baby after the abduction occurs.

Figure: Learn how to prevent infant abduction at your hospital.

There's no guarantee that an infant abductor will fit this description, so prevention is the best defense against infant abductions.

Since 1998, The Joint Commission has considered infant abduction a sentinel event. Given this fact, it's vital that nurses are trained and ready for when a code pink occurs. Safeguarding infants requires teamwork and education. The code pink team needs to include nurses, parents, physicians, and security, as well as coordination of various elements of physical and electronic security measures. Most healthcare facilities are equipped with locked doors, surveillance equipment, and baby ID bracelets that trigger an alarm on the unit. These are all necessary ways to prevent abduction, but consider the instance when the abductor is able to remove the ID bracelet. What then?

In most hospitals, there's a visitor and staff identification policy. Nurses swipe their ID cards to the locked maternity or pediatric unit, but guests must be buzzed in. All staff must strictly adhere to these hospital policies. This involves a great deal of teaching on the part of the nurse to ensure that our tiniest patients and their mothers are safe. But what if the abductor does make it onto the maternity unit and is armed with a weapon? Are nurses ready to deal with a possibly violent abductor?

Nurses must be prepared to not only protect the infant, but also protect themselves and their colleagues from harm. The following are some guidelines all nurses should follow when presented with a code pink. Most important, if you suspect an abduction is happening, never engage in physical contact with the abductor or the baby, instead:

• Call a code pink when an infant is missing or known to have been kidnapped.
• Adhere to strict policies and procedures set by the healthcare facility.
• Report to the appropriate personnel immediately if a code pink is suspected.
• Educate mothers and all staff about visiting hour policies and procedures.
• Staff must present proper identification to the infant's mother at each interaction.
• Avoid giving information about your patients (the mother and the infant) over the phone.
• Leaving the infant unsupervised is a never occurrence.
• Only authorized personnel may transport the baby.
• Transportation of the baby will always be in a bassinet.

Infant security experts agree that an informed mother is the baby's first line of defense while in the hospital. It's essential that nurses educate new mothers about the psychological profile and modus operandi of a typical abductor. Considering the severity of this discussion, it's important that educational material be provided in a kind but direct manner. This is usually the happiest of times for new mothers, so delicacy when discussing this issue must be considered. Remember that some mothers may be recovering from a cesarean section, so you must explain this information to the father or partner of the mother.

Educational material can also be provided in written form and signed by the mother. This certifies that not only has the mother received the appropriate material, but also that she understands the material and has a responsibility to participate in the protection of her infant during the hospital stay.

Educate the mother about the following:

• code pink procedures
• ID bracelets
• visiting hours and policies
• preventive strategies, such as being suspicious of casual acquaintances or strangers that attempt to befriend her, being aware of strangers that come to her door to see the baby, asking all staff members to show her their ID, avoiding giving information about her and the baby over the phone to strangers, and informing staff if she must leave the infant unattended.

Discharge instructions should include never leaving the baby alone at home, not putting a birth announcement in the newspaper, and calling the police if the parents are suspicious or concerned about the baby's safety.

The consequences of a code pink can be devastating not only for the parents, but also for the hospital. Locked doors, ID bracelets, and regular code pink drills enhance the security posture of a healthcare facility. As nurses, we must continue to work toward providing a safe environment for babies, their families, and our fellow healthcare workers.