_________ ___ _______ _______ ______ ____ _________ _______ ___ ___ ________ ____ _______ ____ __ ______ ________ ___ _________ _______ ___ ____ ___ _______ _____ ___ ___ _________ ______ A Comprehensive Newborn Falls Prevention Strategy: The First Two Years Rose Mary Ainsworth, RN, MSN, Jeanette Atkinson, RN, Cathy Mog, RN, Shelley Summerlin-Long, RN, MPH, MSW Huntsville Hospital for Women & Children, Mother/Baby Unit, Huntsville, Alabama Background and Project Objective Staff Education and Tools Results and Conclusions Common factors in falls events: Cesarean delivery, narcotics use, feeding times, early morning hours Anonymous survey administered to staff to assess usage of individual components of newborn falls protocol - at 6 months and 1 year 100% of staff attended Newborn Falls class 99% reported having read new Newborn Falls policy Round 1: 89% of nurses report using the Newborn Falls Assessment at least once each shift; 95% in Round 2 Staff Survey on Implementation of Newborn Falls Protocol Scale: 1 = Never 7 = Always Huntsville Hospital has had three fall incidents in past two years since falls protocol implemented, but they do not fit previous pattern. In one case, infant fell from mother’s arms but not from bed as mother’s siderails were up. Mother/Baby administrators and staff plan to continue use of staff and family educational tools and the Newborn Post-Fall Debriefing Form to evaluate all future infant falls and to develop additional tools and strategies as indicated by future data collection. Other hospitals seeking to reduce and prevent newborn falls may learn from Huntsville Hospital’s experience in its newborn falls initiative. Baby drop definition – “A fall in which a newborn, infant, or child being held or carried by a health care professional, patient, family member, or visitor falls or slips from that person’s hands, arms, lap, etc. when a child is being transferred from one person to another. The fall is counted regardless of the surface on which the child lands (e.g. bed, chair, or floor) and regardless of whether or not the fall results in an injury.” (National Database of Nursing Quality Indicators [NDNQI], fall indicator established for 2nd quarter, 2013) Issue of newborn falls (drops) in the hospital only recognized as a problem in recent years Little in literature to provide evidence-based guidelines for uniform health care policy response Hospitals developing own strategies for reduction/prevention of newborn falls Huntsville Hospital had 7 newborn falls in 7 month period (Dec. 2011-July 2012), and the issue of Newborn Falls was designated a Quality Initiative Objective: To reduce and prevent newborn falls at Huntsville Hospital for Women & Children Staff educated on falls through required class, staff meetings, emails and flyers Newborn Fall Risk Assessment Tool created and implemented in September 2012. Nurses assess patients at least once a shift and as needed when variables change during shift. Newborn Post-Fall Debriefing Form created for use by health care team after fall events Family Education Large focus on educating families about newborn fall prevention Nurses educate family members on falls at beginning of each shift, when giving pain medication and as needed Patients instructed to call nurse before and after infant feedings so that four siderails can be raised/lowered as falls prevention method. Reminder posters in patient rooms (siderails policy approved by hospital administration) Falls information added to Infant First Instruction and Safety Sheet read and signed by patients at admission (in English and Spanish) Information on newborn falls posted on mirrors in patient bathrooms Postpartum booklets and crib cards updated to include information on newborn falls Methods Mother/Baby unit staff formed a committee to: Review information from the 7 fall events, other hospitals’ experiences and the literature Review of 7 fall events included variables such as type of delivery, maternal pain medication/PCA use, time of day fall occurred, where baby was, whether baby feeding, and other circumstances at time of fall. Create a policy on newborn fall prevention Develop education and tools for family members and staff References Newborn Falls Policy Abike F, Tiras S, Dunder I, Bahtiyar A, Uzun OA, Demircan O. (2010). A new scale for evaluating the risks for in-hospital falls of newborn infants: a failure modes and effects analysis study. International Journal of Pediatrics, 2010, 9 p. Helsley L. (2011). Newborn falls/drops in the hospital setting.  [PowerPoint slides].Retrieved from http://www.mnhospitals.org/index/tools-app/tool.362/ Helsley L, McDonald JV, Stewart VT. (2010). Addressing in-hospital “falls” of newborn infants. Joint Commission Journal on Quality and Patient Safety,36(7), 327-33.   Monson SA, Henry E, Lambert DK, Schmutz N, Christensen RD. (2008). In-hospital falls of newborn infants: data from a multihospital health care system. Pediatrics, 122(2), e277-e280. National Database of Nursing Quality Indicators (NDNQI). (2013). Nursing Quality News, 14(1), p. 3. Paul SP, Goodman A, Remorino R, Bolger S. (2011). Newborn falls in-hospital: time to address the issue. Pract Midwife, 14(4), 29-32. Phalen AG, Smolenski J. (2010). Newborn falls: seeking solutions for a never event. Journal of Obstetric, Gynecologic, & Neonatal Nursing (Special Issue: Proceedings of the 2010 AWHONN Convention), 39(1), S46. Ruddick C, Ward Platt M, Lazaro C. (2010). Head trauma outcomes of verifiable falls in newborn babies. Arch Dis Child Fetal Neonatal Ed, 95, F144-F145. Schwartz DL, Hitchcock SC. (2012, June). Help! Our babies are falling!: A maternal-newborn case study. Poster session presented at the national conference of the Association of Women’s Health, Obstetric, and Neonatal Nurses, Washington, D.C. Policy and Procedure on Newborn Falls Prevention created and implemented in July 2012 Addresses parental education, infant transport, placement of infant for sleeping, review of maternal medications, assessment of environment and mother’s level of consciousness, and required actions in the event of maternal seizure precautions