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In today's world, most medical facilities are going the extra mile to ensure that newborn babies are safe. Today most hospitals take a number of steps to identify newborn infants through provisional DNA matching. Most facilities have more structured controls for visitors, such as banding the parents. L& D units generally employ the use of various technologies such as CCTV systems, card access control, lockdown systems and electronic infant tag systems. In addition, most hospitals have backed up these electro/mechanical remedies with various protocols aimed at staff behaviors that are consistent with sound security practices. Many hospitals do periodic abduction drills.
Ironically however, even with stepped-up security for infants, one of the pitfalls that will often go along with the use of integrated technology is clinical staff complacency. It is not unusual, where there is extensive use of security technology for the L&D staff, as well as the postpartum staff, that they perceive this technology as omnipotent. They believe the security systems will take care of everything, so they can relax. This perception can lead to disastrous results. We at SMSI™ have been retained as experts in numerous hospital security lawsuits. The recurring theme in most of these lawsuits was lack of staff vigilance and involvement. In most cases, it was not the fault of the security staff. It was not that there were insufficient cameras. It was not the fault of inadequate access control.
The more likely scenario was (an actual occurrence): A nurse allowed the perpetrator to coat-tail her through a card access control point. Another nurse witnessed the perpetrator carrying the baby (most units insist babies are moved about in bassinets only). Finally, a third nurse held the door of the unit open for the abductor as she left the unit. The census count did not notice the missing infant until after the perpetrator had cleared the campus.
When one looks at many hospitals across the country, one finds that whether the infant security system is good, fair or moderate, there is a great deal of disparity between the infant security program and the pediatric security program. There also seems to be disparity in the available data for pediatric security breaches, as a unique category. The National Center for Missing and Exploited Children (NCMEC) and well as JCAHO maintain data for infant abductions, while data for pediatric security breaches is lacking. The lack of good data may be, in part, the source of the problem. Without good information there is less impetus to act. Moreover, in recent years JCAHO has focused attention on infant security, which in part, may account for the disparity.
Even some of the data for infant abduction seems skewed in the opinion of HSR. For example, JCAHO contends that the number one root cause of infant abductions is unmonitored entry/exit points. This conclusion seems contrary to our, albeit anecdotal, experience. Our litigation experience indicates that the most pervasive gap in most hospital security programs, including infant abductions, is relaxed vigilance on the part of the clinical staff.
Question: Does the infant security program at your hospital establish a standard of care against which your pediatric security program will be measured in the event of a security failure? This is a question every hospital must consider.
Before taking any action, it is important to remember that security is a very situational discipline. One size does not fit all. What is prudent and reasonable for one hospital may be inadequate for another. Initially, a security assessment should be conducted by a qualified security professional, preferably hospital-wide. For the well being of all patients and staff, the assessment should include the entire hospital and should be done every two to three years. Assessing a specific area within the greater whole of the entire hospital affords only moderate benefits because the entire security program must be fully integrated. Contrary to popular opinion, qualified security assessments often pay for themselves. They ensure that budgeted security measure are appropriate and are actually producing measurable results.
Security for pediatric patients must begin at the admission process. We believe hospitals have an affirmative duty garner certain information about the patient. The range of pediatric patients can include the smallest infant up to children in their late teens. Therefore each admission must include an inquiry that assesses the patient's risk profile. For example, such information as: Is the child part of a custody dispute? Are there protective orders (restraining orders) issued on behalf of the patient? Is the child the victim of abuse? Is the child the victim of gang violence? Are the child's parents high profile public figures?
The hospital generally has an affirmative duty to try to glean this information and to document the effort. Based on the cluster of risk factors, appropriate actions must be taken. The development of these protocols should involve a qualified security professional, risk management and the safety committee.
In preparation for writing this article, the Hospital Security Reporter (HSR) spoke to security managers for major medical centers in California, Pennsylvania, Massachusetts and New Hampshire. Additionally we spoke to officials with NCMEC. The security managers we spoke to are ahead of the curve in that they have realized the threat and are affirmatively addressing the problem. These security professionals, along with the NCMEC folks seem to indicate, that in many ways pediatric patients may be at greater risk than are newborn infants. NCMEC indicates that they believe the greatest threat for abduction of a pediatric patient is a non-custodial parent. Some hospitals are selectively using the tag systems applied to their infant program for some pediatric patients. Others have beefed up their access control systems and have expanded their CCTV coverage. Visitor control programs have also been stiffened. However, all agree that pediatric security is overlooked by many hospitals.
NCMEC believes that, although this is a different kind challenge, pediatric security programs should be comparable with their infant abduction prevention programs. It is also important to realize that merely satisfying JCAHO EC Standards will not guarantee the safety of pediatric patients nor will it reduce culpability. Many hospitals have traditionally waited for the "wheels to come off" before acting. It was gratifying to find hospitals that chose the proactive option.
Abduction is not the only security concern in pediatric units. We have had cases involving assault and sexual assault of pediatric patients. We at SMSI™ would rather have the opportunity to help prevent security problems. We would prefer to not have to analyze the security shortfalls as an expert in a lawsuit.
HSR's point is this: If your hospital finds itself defending a lawsuit for inadequate security on your pediatric unit, or your children's hospital, you might find yourselves in the position of having to justify the disparity between your pediatric security program and the infant security program. |
