MAGNET MONDAY: Bedside scientist grant decreases newborn falls

Posted on July 28, 2013 by Chona H.

From July 2011 through June 2012, the Mother/Baby Unit (MBU) noticed a spike in newborn falls (drops). Six infants were dropped by their parents. Fortunately, none of them suffered any injuries.

AAMC’s Quality Council decided to look at this problem more closely and developed a Newborn Falls Prevention Task Force. At first, it was made up of only MBU and Women’s Surgical Unit (WSU) nurses, but since this issue is relevant to all areas of Women’s and Children’s services, we invited representatives from Labor & Delivery, NICU and Pediatrics.

When we looked into falls that occurred since 2009, we noticed almost every fall occurred during the night shift and involved a parent holding the baby and falling asleep. We also reviewed the literature and several poster presentations at the AWHONN Convention in 2012. After looking at the problem and what has been done to address it, we decided to focus on doing a better job educating our families and increasing their awareness of the newborn falls.

With the help from our marketing department, we developed two handouts:  “Protecting Your Baby” for the postpartum areas and the NICU and “Protecting Your Child” for Pediatrics.  In addition, we placed signs in patient rooms that state “When you Doze Off, Baby Rolls Off,” and instructed parents to put their baby in the crib if feeling sleepy. Handouts and signs are in English and Spanish. At the front door of M/B and WSU, we have signs telling families the number of days since our last newborn fall. Nurses and PCTIIs document once every 12-hour shift about teaching parents how to prevent newborn falls.

In FY13, we had only two newborn falls. Families comment that they had no idea newborns were at risk for being dropped and they are thankful for the education. One NICU nurse said while teaching a father about falls prevention, he quoted the number of days since the last fall and said he wasn’t going to break the streak!

We were fortunate to receive a Bedside Scientist Grant in July 2012.  The $1,000 paid for our translation services and for our new posters. It was also used to send some members of our task force to the Maryland Patient Safety Conference in April 2013, where we presented our Newborn Falls Prevention poster.

Mary Hantske RN, MSN

Clinical Educator, Mother/Baby, Women’s Surgical Unit