Infant security

A hotel concept?

A nightmare scenario for a hospital would be receiving a phone call that an infant patient is missing. A missing baby touches the core of healthcare and its security. Healthcare providers know the importance of safety, which includes a broad spectrum of hot topics in the public's eye. Keeping a child secure from potential abduction while in the hospital is one of them.

St. Alexius Medical Center in Bismarck, N.D., has historically developed programs and updated policies to provide infant security within our facility. These programs included, but weren't limited to, education, policy development, nursery locking, and infant identification processes that promoted security for the children entrusted in our care. Unfortunately, in the spring of 2007, there was a nationally publicized infant abduction case that occurred in an out-of-state healthcare facility. Shortly thereafter, a multidisciplinary team meeting was convened to review our existing infant security program and explore opportunities for improvement. The team initially consisted of representation from security, engineering, and nursing leadership. We carefully reviewed the out-of-state incident, revealing the use of an infant tagging system that still resulted in the abduction. We knew our infant security focus for improvement needed to center around prevention. We had reviewed infant alert tagging systems that provide alerts when an infant is taken out the door. The team's focus was facility prevention of abduction.

Prevention focus

Prevention focus was difficult because the Birth Place, consisting of a separate labor/delivery unit, mother/baby unit, and neonatal ICU, is located in the heart of the medical center. Several entry points and heavy traffic flow are a main stay of the area. Our discussion included investigating infant security at other North Dakota hospitals, reviewing our drills, exploring existing identification programs, and beyond. A gap analysis, utilizing the ECRI Institute's Healthcare Risk Control self-assessment questionnaire related to preventing and responding to infant abductions, was conducted to identify areas for improvement. The questionnaire based its materials on documents from The Joint Commission and the National Center for Missing and Exploited Children.¹

One of the key changes identified was limiting access to unwanted visitors. The initial discussion was "just lock the unit." Although the nurseries had been locked for several years, the mother/baby unit posed a more complex problem. There were several entry points for this unit both vertically and horizontally, and inhibiting traffic for healthcare staff wouldn't be conducive to workplace flow. Subsequent meetings were held with the directors of facilities, security, and women/children services, each sharing their perspective in regard to locking. The question was then posed, "Why don't we lock individual patient rooms just like a hotel?" At first we thought this was an outlandish idea, but soon it became the pivotal turning point for a concept beyond our imagination.

The team met with administrative representatives and began examining the possibility of locking individual mother/baby patient rooms with guest card key passes. Guest card key passes would be issued only to those wearing matching infant ID bands to the baby, typically the parents. This novel idea would hopefully engage parents to play an important role in the security of their new baby, including keeping room doors shut and locked to prevent unwanted visitors. It was anticipated that parents would take personal responsibility for the security of their child right from the beginning and then continue that practice of safety when returning home. The individual room locks would have to be conducive to the patient care routines needed for both the mother and baby, so staff access was a priority. Due to improved technology, we were able to order a system that would meet these objectives. The plan also included other items such as updating parent education, information, and policies related to this new concept.

The team expanded to include unit staff, risk management, and local law enforcement. Plans were reviewed and input gathered from these valuable resources. The team also recognized that physician communication and understanding of the plan was important for obstetricians, pediatricians, and neonatologists.

The architectural engineer for the medical center thought the hotel concept of individually locking rooms was a novel idea and one that would work for St. Alexius Medical Center. The initial cost involved to secure individual rooms was relatively cost efficient compared with building a whole new wing in a more remote area of the medical center.

Making it happen

In January 2008, the "hotel concept" was on its way. We ordered hardware and technology to secure individual patient rooms, and the installation would follow. Processes, policies, patient education, and staff education were developed and ready for implementation simultaneously with the completion of the project. Additionally, a guest services check-in desk was placed at the Birth Place main elevator entrance. The desk, staffed by volunteers during select hours, assisted in traffic flow and visitor identification. Volunteers were trained to greet visitors and connect patients with their guests. The volunteer inquired by phone first if the patient wanted a visitor and then provided escort services to the privately locked room.

Several mandatory education sessions were completed in May 2008 for staff, security, and leadership. Engineering completed hardware installation and the new security system was activated in June 2008.

Parent satisfaction

The project has been successful to date. Patient satisfaction and card key monitoring is in place. A quality monitor was conducted following the first quarter of implementation and repeated in April 2009. April data revealed private locked rooms enhanced 96% of respondents' sense of security. Parents have been very supportive of the new system. Some of their comments include:

• "Nice to know everyone cared about our security."
• "More privacy was nice, it helped me relax and rest."
• "Great new feature—slept better knowing doors were locked."
• "I like the feature very much, especially when nursing."

All in all, the enhanced infant security program has had a positive effect on our patients and has complemented increased security for welcoming our world's future!