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As of May, American hospitals had gone 21 months without an infant being abducted from one of their facilities, which is the longest time ever since data has been collected on this crime. The good news indicates that healthcare providers have gotten the message about abduction prevention, but some experts point out that teen-agers are more likely to be taken or leave on their own.
Infant abduction is high on the list of nightmares that every risk manager wants to avoid, and providers have taken several precautions in recent years, including the use of proximity alarms on infants, tighter security on obstetrical floors, increased vigilance by staff, and education for parents about the risks. Despite the lack of abductions, those precautions are warranted because there have many attempted abductions, says John B. Rabun, ACSW, director of infant abduction response at the National Center for Missing & Exploited Children (NCMEC) in Alexandria, VA. The attempts failed because of heightened awareness by staff and parents or because the physical security assets worked, Rabun says.
"Since we know there have been scads of potential attempt abductions, many coming in through the ED, my hat’s off to all our healthcare folks for keeping the target hardened" by implementing safeguards that make the hospital a difficult place to abduct a child, he says. "My fear is our success might lend itself to complacency, if we’re not careful," Rabun says.
That complacency might occur more with older pediatric patients rather than infants, he says. NCMEC recently compiled information from their database showing 1,689 children were reported missing from healthcare institutions between 2000 and 2013. Notably, 1,591 of them were "endangered runaways," who are minors who are not in the care of their parents, exposed to danger from life on the street, and prone to run away from the hospital. In most cases, the endangered runaways left of their own volition, Rabun explains. Family abductions accounted for 77, nonfamily abduction accounted for six, and the circumstances were unclear in 15 cases. The data suggests that while preventing infant abduction is important, risk managers might need to expand those efforts to include older children.
The runaways, whether they are teen-agers or younger, must be considered endangered, Rabun says, and their absence should be taken seriously. "If we lose a kid, even if it’s because the kid ran away, there is still liability there, and we have to do our part to get law enforcement involved and find him," he says. "Hospitals have to treat children and teen-agers, and they bring the rest of their life with them. Some will be in the midst of family dissolution cases such as divorce or custody battles, and some will be unwilling to stay for different reasons. We can’t turn the hospital into a juvenile detention center and lock everybody up, but we have to recognize that losing a child is serious business, even if it is not an infant."
The NCMEC data on runaways offers an opportunity to encourage more vigilance with older pediatric patients and particularly those who are troubled, says Staca Shehan, director of the case analysis division at the NCMEC. "It’s clear from the numbers that the healthcare community has taken seriously the risk of infant abductions, and the data also shows that they could have a real impact on these older children who sometimes need someone to intervene," Shehan says. "The awareness of child safety in healthcare has increased significantly in recent years, and this data directs us to where we can have even more impact."
The philosophy on protecting children older than infants is similar to that for preventing newborn abductions, but it is complicated by the fact that older children can run away on their own. Still, hospitals can apply some of the same prevention efforts and expect similar success, he says.
As with infant abduction, the tricky part for a risk manager is to address the risk without overdoing it. The statistics on missing children and teen-agers, though higher than for infants, still don’t indicate they are common at hospitals. The potential impact of losing a child is great enough, however, to warrant prevention efforts.
Many hospitals regularly conduct Code Pink drills for infant abductions, Rabun notes, but not as many devote the same effort to older children with Amber Alert drills. (For more on Code Pink and Amber Alert drills, see the story on p. 76.)
"When I travel to hospitals I see targets that are pretty well hardened, even if they may be missing a few pieces, mostly because they don’t understand the profile of the offender," Rabun says. "Are hospitals more secure for infants than they were 10 years ago? Oh yes. But can you say that necessarily about [older] pediatrics? It’s safer, but probably not on the same level as the newborns."
Most of the same precautions that have proven effective in neonatal units can be used for older patients as well, says David LaRose, MSCJ, CHPA, CPP, director of safety, security, and emergency management at Lakeland (FL) Regional Medical Center. He also is president-elect of the International Association for Healthcare Security and Safety, based in Glendale Heights, IL. Think of protecting all children at the hospital with one policy that includes staff and parent education, and then tailoring some precautions to fit the different age levels, he suggests.
Security bracelets can be used for older children as well as newborns, for example, although LaRose notes that teenage patients might refuse to wear them. (See the story on p. 76 for more on technological solutions.)
"A lot of hospitals declare their pediatric unit security-sensitive the same way they do with perinatal, so you have the same access control, staff intervention, and parent education," Larose says. "There is a consistent return on investment when you can utilize the same technology, the same staff and parent education, to address older children. You won’t have to start from scratch looking for a solution and paying for new ways to address the risk."
In addition to Code Pink drills for infants, Lakeland Regional conducts Amber Alert drills for older children. The drills are an opportunity to spot any deficiencies with technology or staff and parent education, as well as policies and procedures that might be improved, LaRose says. A particular concern is training new staff quickly so there are no lapses.
At South Nassau Communities Hospital in Oceanside, NY, infant and older pediatric security are addressed with one prevention and response plan, says Director of Nursing Gayle Somerstein, RN. Her hospital has addressed pediatric security for years by extending infant security precautions to older children as well.
"Whatever is done in our maternal child area is done throughout the facility for pediatric patients as well," she says. "Anyone 17 and under gets tagged with a transponder, and the pediatric unit is a locked unit accessed only by people with credentials and a reason to be there."
To improve security for older pediatric patients, especially those who might run away, Somerstein’s hospital allows parents or a designated family member to visit 24 hours a day and strongly encourages them to stay with the child during the day and at night.
Rabun notes that he is not familiar with any situation in which a family sued a hospital after a child ran away or a non-custodial parent took him or her. He suspects there have been informal settlements in which the hospital quietly offered some type of compensation, either monetary or in the form free healthcare, to avoid a lawsuit.
"I think that’s rational," Rabun says. "We’re seeing much better capture of intake information at the pediatric level, because in many of the cases in which a parent stole a child it was because the other parent didn’t say anything that would let the nurses take precautions."
Nurses or admissions clerks should ask the parent or parents admitting the child whether there is anything going on at home "that might impact your child’s stay here with us." If that prompts a blank stare from the parents, Rabun says, follow up with examples: "Any family issues like a divorce or custody dispute, family disagreements, anything like that?" The query can bring forth information that the parents might not otherwise have offered because they thought the hospital staff would not be interested or be able to do anything about it. When the nurses know that parents are in a custody dispute, for example, they can be on alert and check identification.
"Abductions by family members are potentially very bad situations, even though it’s the child’s own mother or father," Rabun points out. "Unlike an infant abduction where the person desperately wants a child, these children are objects of spite, not objects of love. That can lead to at least a neglect situation, if not something much worse."
Healthcare Risk Management is proud to receive a first place award in Best Interpretive or Analytical Reporting from the Specialized Information Publishers Association (SIPA). The award recognizes an article in the May 2013 issue, "CPR refusal highlights risk of overly strict policies," which addressed the lessons from an incident in which a nurse working at an assisted living home refused to perform CPR on a resident. HRM’s coverage of this highly publicized case went deeper than the general media’s outrage. It analyzed the difficult choices that our readers can face. In addition to explaining the details of the case not previously known to most readers, HRM provided practical advice on how to assess current policies and avoid unintended consequences that can harm patients.
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