Preventing Infant Abduction in Healthcare Settings

1. Preventing Infant/Child AbductionSecurity Awareness for Maternal Child HealthAdapted from National Center for Missing and Exploited ChildrenGuidelines on Prevention of and Response to Infant Abductions (9th ed.), 2009

2. Infant / Child Abduction Plan • Sensitive areas because of infants and children. • Always react as if it is a real alarm • Everyone assigned to a job must perform their job each time there is an alarm • Reduce false alarms • Majority are caused by human error • Example – tags in staff’s pockets, tags left on infant at time of discharge, parents try to take tag as a souvenir, or tag in the trash • Know the by-pass operation when taking infant/child to Radiology or other area for testing • This prevents false alarms • Report any problems with the alarm system to Security as soon as known

3. Report Suspicious People or Activity Immediately • THE “TYPICAL” ABDUCTOR • Female of “childbearing” age (range now 12 to 53), often overweight. • Most likely compulsive; most often relies on manipulation, lying, and deception. • Frequently indicates she has lost a baby or is incapable of having a baby. • Often married or cohabitating; companion’s desire for a child or the abductor’s desire to provide her companion with “his” child may be the motivation for the abduction. • Usually lives in the community where the abduction takes place.

4. Report Suspicious People or Activity Immediately • THE “TYPICAL” ABDUCTOR • Frequently visits nursery and maternity units at more than one healthcare facility prior to abduction. • Asks detailed question about procedures and the maternity floor layout. • Frequently uses a fire-exit stairwell for escape and may also try to abduct from the home setting. • Usually plans the abduction, but does not necessarily target a specific infant/child; frequently seizes any opportunity present. • Frequently impersonates a nurse or other healthcare personnel. • Often becomes familiar with healthcare staff members, staff members work routines, and victim parents. • Demonstrates a capability to provide “good” care to the infant/child once the abduction occurs.

5. Report Suspicious People or Activity Immediately • THE “TYPICAL” ABDUCTOR In addition, an abductor who abducts from the home setting: • Is more likely to be single while claiming to have a partner. • Often targets a mother whom she may find visiting healthcare facilities and tries to meet the target family. • Often plans the abduction and brings a weapon, although the weapon may not be used. • Often impersonates a healthcare or social-services professional when visiting the home. There is no guarantee an infant abductor will fit this description. Prevention is the best defense against infant abductions. Know whom to look for and that person’s mode of operation.

6. Infant/ Child Abductions From Healthcare Facilities • While not a crime of epidemic proportions, the abduction, by nonfamily members of infants, birth through 6 months, from healthcare facilities has clearly become a concern. • Typical abduction from a healthcare facility involves an “unknown” abductor impersonating a nurse, healthcare employee, volunteer, or relative to gain access to an infant. • Because there is easier access to a mother’s room than a newborn nursery, most abductors “con” the infant directly from the mother’s arms. This can also happen in the pediatric department.

8. The Crimes are not Always Committed by a “Stranger” • Offenders make themselves known and achieve some familiarity with healthcare personnel, procedures and the victim’s parents. • Often visits the maternity unit and nursery for several days before the abduction. • Repeatedly asks detailed questions about procedures. • Familiarizes themselves with the layout of the maternity unit. • Some abductors are former employees, former patients, or have a friend or relative who was a patient at the facility where the crime was committed.

9. The Crimes are not Always Committed by a “Stranger” • Impersonate nurses or other healthcare personnel wearing uniforms or other healthcare-worker attire. • They have also impersonated home-health nurses, staff with financial-assistance programs, and other healthcare professionals. • Often visit more than one healthcare facility to assess security measures and explore infants/children, like “window shopping”. • May not target a specific infant/child. “Snatches” the infant/child when an opportunity arises and makes a quick exit, often via a fire-exit stairwell. • Often focuses on a Mom’s rooms located near a stairwell.

10. General Guidelines For Healthcare Professionals Safeguarding infants and children requires: • Comprehensive policies, procedures, and processes • Education • Coordination • A multi-disciplinary approach • Electronic security measures serve as a “back-up” to policies, procedures, and nursing practice

11. What Can You Do to Prevent Infant Abduction? • Be alert to unusual behavior. • The protection of infants and children is everyone’s job, not just Security’s. • One of the most effective means is simply asking “May I help you” and “Who are you here to visit?” • Make eye contact when asking questions. • Carefully observe the person’s behavior. • Note physical description. • Follow-up appropriately for the situation. • Be aware of strategically placed video cameras throughout the departments (Record 24 hours/day, 365 days a year).

12. Unusual Behavior • Repeated visiting or requests “just to see” or “hold” infants. • Close questioning of procedures, security devices, and layout of the floor such as “Where are the emergency exits?” “Where do the stairwells lead?” “How late are visitors allowed on the floor?” “Do babies stay with their mothers at all times?” • Taking uniforms or other means of identification. • Physically carrying an infant/child in the facilities corridor instead of using a bassinet or wheelchair. • Transporting infant or leaving with an infant while on foot rather than in a wheelchair. • Carrying large packages off the maternity unit, particularly if the person is “cradling” or “talking” to it.

13. Creating a Diversion • Be aware that the abductor may create a diversion in another area to facilitate the infant/child abduction, including: • Pulling a fire alarm near the nursery. • Threatening argument in the waiting area.

14. General Guidelines • Anyone demonstrating suspicious behavior should be immediately asked why they are in that area of the facility. • Immediately report the person’s behavior to the charge nurse, nurse manager/nursing supervisor, and Security. • Positively identify the suspicious person, write down what you see, and keep him/her under close observation. • Age • Race • Eye color • Height • Weight • Hair color • Clothing • Anything unusual about the individual (limp, birth mark, glasses, tattoos etc.)

15. General Guidelines • Suspicious person should be immediately interviewed by the nurse manager/ nursing supervisor and Security. • Caution needs to be exercised when interacting with people who exhibit these behaviors.

16. Proactive Prevention L&D • Educate the mother/support persons/guardian regarding all safety procedures and document on the PFER. • Immediately after birth of the infant and before the mother and infant are separated, attach identical ID bands to the infant (2 bands) and mother (1 band) and 1 band to the support person of the mother’s choice. • The delivery room nurse will write the delivery date, time of delivery, and sex of the infant on all four bracelets. • Educate mother/support persons of the reason and need for the ID bands.

17. Proactive Prevention • If the fourth ID band is not used, it will be cut in pieces and placed in the HIPAA bin. • An infant’s ID bands must be verified by the mother prior to the infant leaving the mother’s room for care, and upon return to the mother’s room. • The nurse must examine and verify the identification information on the infant’s and mother’s/ support person’s ID bands. • The mother should participate in the identification process. • Mother’s first and last name, MRN number and infant’s birth date are verified.

18. Proactive Protection L&D • If an infant band is removed for medical treatment or comes off for any reason, immediately reband the infant after identifying the infant, using objective means such as footprint comparisons or blood testing • Apply new bands to the infant, checking mother’s first and last name, mother’s MRN number, infant sex, date of birth, and birth time. • If the band is cut or entirely removed the mother/ support person should be present at the removal and replacement.

19. Proactive Protection L&D • Prior to removal of infant from birthing room or within a maximum of two hours of the birth: • Footprint (with emphasis on the ball and heel of the foot) the infant, making sure the print is clear and readable. • Perform a full, physical assessment of the infant, and record the assessment, along with a description of the infant in the medical record. • Identify and document any marks or abnormalities such as skin tags, moles and/or birth marks.

20. Proactive Protection L&D • Prior to removal of infant from birthing room or within a maximum of two hours of the birth: • Store a sample of infant’s cord blood until at least the day after the infant’s discharge. • Place electronic security tag on infant’s umbilical cord clamp or leg bracelet after verifying that the tag is working. • Log security tag into security system using the correct infant name and room number. • Placement of security tag is checked with each infant assessment and when an infant is transferred to 1B, L&D or NICU.

21. Proactive Protection -Pediatric Patient • Nurse will obtain a two part pre-numbered bracelet set and write patient informationon bracelets. • ID number is documented in EMR. • One bracelet placed on the child’s arm or leg and second bracelet placed on the parent/ guardian’s arm. • These bracelets are used during the hospitalization period to match the child with his/her parent(s)/guardian. • Log security tag into security system using the correct child’s name and room number. • A bracelet with a security tag is placed on the child at time of admission. • .

22. Proactive Protection- Pediatric Patient • Placement of security tag is checked with each pediatric assessment and when a child is transferred back to the unit after a procedure/surgery • If bracelet is removed, a new set of bracelets must be immediately placed on the child and parent/support person. The old bracelet set is cut up and placed in the HIPPA bin. • The security tag is removed immediately prior to discharge. • The bracelets and numbers of the child and the parent/ support person are verified prior to discharge of the child.

23. Proactive Protection • Require all healthcare-facility personnel to wear their name badges above the waist and “face-side” out so the person’s name and title are easily identifiable. • All maternal child employees have a pink stripe on their name badge. • Mothers and support persons are instructed to only allow nurses who they know and who also have a pink stripe on their badge to take their infant/ child out of the room for tests or procedures.

24. Proactive Protection • Infant/child transportation within the healthcare facility • When an infant/child is transported within the healthcare facility, he/she must be accompanied by a MCH nurse who is wearing the authorized pink striped name tag. • Mother/support person/guardian is encouraged to accompany infant/child if taken off of the unit for testing.

25. Proactive Protection • Prohibit “arm carrying” infants, and require all transports to be via a bassinet. • Always place infant in direct, line-of-sight supervision either by the mother, support person or staff member. • Address the procedure to be followed when the infant is with the mother and she needs to go to sleep/ the bathroom and/or is sedated. • Always place the mother’s bed between the infant’s bassinet and the exit door to the room.

26. Proactive Protection at Discharge from L&D and 1B • At discharge nurse compares infant’s ID bands to mother’s ID band. • Remove one infant ID band and tape to Hollister Footprint form. • Mother signs the Hollister Footprint form to acknowledge bracelet check. • Nurse removes infant security tag immediately prior to discharge. • Nurse discharges infant security tag from infant security system. • Mother is discharged per wheelchair holding infant in her arms or in a car seat. Support person is not permitted to carry infant.

27. Proactive Protection in NICU • Each family member should be positively identified and documented by nursing staff members. • Visitors approved by the parents must be carefully observed and not allowed near any other infants. • A number of abductions from NICUs’ have involved family members of infants who were on “court hold” for such reasons as positive drug screens and custody issues, infants awaiting adoption and guardian ad-litem situations.

28. NICU Infant Security Risk Issues • Potential infant security risk issues: • Infant care procedures resulting in numerous infant ID band changes due to reinsertion of IVs’, edematous extremities, or infant weight gain. - The removed ID band should be cut up and placed in the HIPAA bin. - Reband infant with another ID band that matches the mother’s/ support person’s ID band.

29. NICU Infant Security Risk Issues • Potential infant security risk issues: • Single patient rooms or pods may make it difficult for line-of-sight observation of infants at all times. • False sense of security that infants are attached to a monitor. • False sense of security that NICU babies are not abducted. • Large, busy unit with multiple caregivers who may not be familiar with the mother/support persons. • Security policies and procedures regarding discharge that are different than L&D – Baby can be carried out in car seat or in mother’s arms if she is no longer a patient in the hospital.

30. Proactive Protection at Discharge from NICU • Require photo ID of mother/support person prior to discharge. Place copy on chart. • At discharge nurse compares infant’s ID bands to mother’s ID band. • Remove one infant ID band and tape to Hollister Footprint form. • Mother signs the Hollister Footprint form to acknowledge bracelet check. • Nurse removes infant security tag immediately prior to discharge. • Nurse discharges infant security tag from infant security system.

31. Pediatric Security Risk Issues • Family abduction is more common in cases involving custody disputes, child abuse, and Department of Family and Children’s Services interventions. • Upon admission nursing staff should ask parent/guardian if there are any personal circumstances the facility should be aware of that may put the child, family or staff at risk.

32. Pediatric Security Risk Issues • Special concern should be placed on single persons who may be involved in a custody dispute or if the mother has a protective order against the infant’s father. • 14% of abductions are from pediatric units. • The constant presence of family should be encouraged for those patients younger than 12 months.

33. Outpatient Areas – MFC, PCC, Lactation and PAE office • Signs should be posted in all waiting areas stating parents and guardians are not allowed to leave infants and children unattended in the waiting area. • All infants/children should be accompanied by an adult other than the mother.

34. Code Pink = Infant Abduction Call 22222

35. Code Pink Drills • Code Pink is called. All MCH staff return to the unit. • Charge nurse will notify Security. • Security will notify: • Senior VP of facilities • Senior VP of hospital • Edgewood Police • FBI • Systems Director for Maternal Child Health • Nurse manager of area • Additional management team members (1B, NICU, LDRP) • Charge nurse assigns staff members to each exit of the unit.

36. Code Pink Drills • Charge nurse and Security- assign staff members to search each open/occupied patient room on the unit, assigns ancillary personnel to assist and search common areas, lounges, locker area, waiting rooms, storage areas, and utility rooms. • All infants are to be accounted for and other areas thoroughly searched. • If infant missing, areas are searched. A piece of tape is placed on the door of each room to acknowledge the room has been searched.

37. Code Pink Drills • Nurse assigned to patient remains with the patient to assure they are assisted during this time. • Patient may request to be moved, hospital associate is to remain with family at all times. • Nothing in the patient’s room should be moved or removed from the area until Security has given approval. • Contact Social Services and Pastoral Care. • If abduction has occurred, the nurse caring for the patient will assist with a description of the infant/child including photos.

38. Code Pink Drills • Medical Records will be secured • No one should enter or leave the unit until approved by Security. • Names, addresses of all staff, visitors, and patients on the unit will be obtained an interviews will occur with all on unit at time of incident. • All persons entering and leaving the unit will be checked and verified by the Clerical Coordinator. • Patient confidentiality should be maintained and no statements should be given without Security present.

39. Code Pink Drills – Other Departments • Support from other departments when a Code Pink is called overhead: • Monitor hallways and exits. • Be aware of suspicious looking individuals. • Notify Security immediately of any suspicious activity. • Assist MCH staff as directed by charge nurse/ nurse manager/ Security.

40. Key Factors in Helping to Recover an Abducted Infant • Mother reports the missing infant immediately. • Nursing Staff notifies Security, calls a Code Pink and secures unit. • Security contacts law enforcement immediately. • Law enforcement issues a “Be on the Lookout” for BOLO) report immediately.

41. What Parents Need to Know • Be deliberately watchful over the infant/child. • Never leave infant/child out direct line-of-sight even when going to the restroom, taking a shower, or taking a nap. • When possible, keep bassinet on the side of your bed away from the door(s) leading out of the room. • Ask questions about routine nursery/pediatric procedures, feeding times, visitation policies, and other security measures. • Do not give infant/child to anyone without properly verified identification issued by the facility.

42. What Parents Need to Know • Ask nursing staff what specifies their badges as different than the rest of the facility. • Question unfamiliar persons entering your room or inquiring about your infant/child – even if they are dressed in the hospital’s attire or seem to have a reason to be there. • Notify the nurses station immediately if you have any concerns. • Determine where infant/child will be taken if he/she must leave the room. • Ask what tests are going to be done and how long the infant/child will be gone.

43. What Parents Need to Know • Find out who authorized the test/procedure. • If there is a concern about the infant leaving the room go with the infant or send a support person. • Have at least one color photo of the infant/child. • If a home visit is going to occur, ask for a written set of guidelines for the visit. • Do not allow anyone into the home without proper facility identification.