Are you prepared for an abandoned baby?

You’re probably prepared for victims of heart attack, stroke, and trauma, but an abandoned infant can throw a monkey wrench into almost any ED, says Sherri-Lynne Almeida, RN, MSN, MEd, DrPH, CEN, vice president of client services for Team Health Southwest, a Houston physician practice management company that staffs EDs.

Five states pass laws

Five states have passed child abandonment laws, due to the number of infants being found abandoned in Dumpsters and fields, Almeida explains. "These unwanted infants may wind up in your ED," she warns. (See related story summarizing state laws, p. 130.)

"The law allows any mother to leave her infant at a hospital if she is unprepared to care for the child, and she will suffer no legal consequences for this action," explains Almeida.

To date, there have not been any test cases in the Houston area, reports Almeida. "Unfortunately, I believe that most mothers who are in this situation are unaware of the law and they are still recklessly abandoning their infants."

However, you must be prepared, because most likely it will be the ED that receives an abandoned infant, warns Almeida. "This situation is such a deviation from the normal traffic seen in an ED," she says. (See ED policy for abandoned children, p. 130.)

Avoid havoc with preparation

Here are ways to prepare for an abandoned infant:

Prepare to care for a newborn.

The ED needs to be prepared to care for a newborn or older infant either directly or indirectly, says Almeida. "Many EDs do not care for children, nor do they deliver newborns," she notes. "Often, if the facility has an OB program, mothers who are about to deliver go directly to the OB unit and bypass the ED all together.

An abandoned baby could create havoc in an ED that is unprepared, Almeida emphasizes.

EDs must be prepared to provide complete inclusive care for this newborn, stresses Jan R. Boatright, RN, CEN, associate director at Priority Mobile Health, a New Orleans-based emergency medical services provider, and president of the Louisiana Council of the Des Plaines, IL-based Emergency Nurses Association.

"There won’t be a mother there to feed, diaper, and monitor the infant," she says. "Cribs and personnel will need to be available until such time as the infant can be forwarded to a nursery, either within the same facility or a facility designated by the department of social services."

Are you prepared for pediatrics?

Create a transfer policy if appropriate.

If your ED isn’t prepared to care for pediatric patients, you’ll have to develop a transfer policy with a receiving facility, says Almeida.

Many hospitals in Houston don’t provide obstetric or pediatric services, she says. "Ideally, it would be nice if the infant could be left at a pediatric facility; however, that is a most unrealistic expectation," she says. Abandoned children in Houston are usually transferred to Texas Children’s Hospital, if the facility that initially received the infant doesn’t have newborn/pediatric facilities or if the condition of the infant warrants more intensive care, Almeida says.

However, transfer can occur only after the infant had received a medical screening exam, she stresses.

Your protocol should include a referral to an in-house nursery if possible, says Boatright. "Our state law says that child services shall take custody and control of an abandoned infant within 24 hours, and the ED is not the best place to provide care for 24 hours."

Obtain information when possible.

Getting medical history of the family are key to the safety and well-being of the infant, stresses Marguerite McCarthy, RN, BSN, director of the ED at Baylor University Medical Center in Dallas.

"The caregiver must be very careful not to scare off the person delivering the child, if such information is to be obtained," she says.

If you are able to speak to the mother abandoning the infant, address her in a nonthreatening tone and be careful to not imply preconceived judgements, Almeida suggests.

Collaborate with services

Work with other agencies.

Although the ED will need to provide medical screening and stabilizing care, a team effort is needed, stresses Barbara Pierce, RN, MN, director of emergency services at Huntsville (AL) Hospital System.

You’ll need a collaborative policy with all involved services, says Pierce. "That includes social services, law enforcement, and newborn nurseries. The goal is to provide the quickest, best possible care for the child," she explains.

Resist the temptation to pass judgment.

Emotions run high with an abandoned infant, and staff might tend to pass judgment on the mother, says Pierce.

"Training may be needed to avoid this," she advises.

The goal is to save babies’ lives by allowing mothers to put children in a safe place anonymously, Pierce emphasizes. "Therefore, staff should encourage this process, not discourage or judge," she says.