|Preventing In-Hospital Newborn Falls: A Literature Review|
|Keywords: Accidental, Falls, Maternal-Child, Maternity Hospitals, Newborns, Nursing.
Abstract: In-hospital newborn falls are arguably one of the most underresearched and underreported issues for organizations that care for newborn patients. From the few published statistics of in-hospital fall rates, we know that perhaps 600 to 1,600 newborn falls occur annually. Many of these falls can result in injury or even death of the newborn, legal issues for the institution, and severe emotional stress to the caregiver(s) and parents. Therefore, we searched the literature to ascertain causation and associated risks associated with in-hospital newborn falls. This is an important issue for nurses to understand because not only can the newborn be harmed due to a fall, but the actual newborn fall can also elicit strong feelings of guilt and culpability in the caregiver(s). This article reviews the literature to examine what is known about the factors associated with in-hospital newborn falls, to explore prevention measures, and to present best practices for how to adopt safe-sleep policy to prevent newborn falls.
Prevention of in-hospital falls among patients is a vital issue for all healthcare organizations. In order to best protect patients, both the Institute of Medicine and the Joint Commission identify patient safety problems, sanction improvement needs, and promote safety system development (Institute of Medicine, 2012; The Joint Commission, 2012). By ensuring the safety of the newborn during hospitalization, medical professionals can promote an overall culture of safety for patients and caregivers. According to Phalen and Smolenski (2010), in-hospital newborn falls are defined as a newborn falling onto the hospital floor accidentally. This can be caused by judgment errors from the hospital staff or caregiver(s), or could be due to environmental factors (Paul, Goodman, Remorino, & Bolger, 2011; Phalen & Smolenski, 2010). The risk of newborn falls begins at the time of birth and continues throughout the duration of the hospital stay.
The issue of newborn falls within the inpatient setting is multifaceted due to the physical, emotional, and psychological complexities for all who are involved. Newborns are a vulnerable population and rely solely on their caregivers to protect them from injuries. Newborn falls concern all stakeholders because of resultant physical trauma to the newborn, legal issues, increased financial costs, and subsequent emotional distress to the family (Monson, Henry, Lambert, Schmutz, & Christensen, 2008).
Due to the minimal amount of information that has been written on this topic, further research is recommended. Other limitations include lack of financial information needed for implementation, unknown number of staff needed to construct and implement a policy, and how a safe-sleep policy will impact the different cultural and ethnic populations. Of the literature reviewed, only one study utilized a developed newborn fall risk assessment (Abike et al., 2010). The creation of a postfall algorithm would be beneficial in order to standardize care for newborns. Due to the underreported nature and underdocumented accounts of in-hospital newborn falls, the true incidence is not widely known. Therefore, an accurate assessment and evaluation cannot be constructed in order to fix the issue.
In order to help prevent newborn falls, facilities should implement and utilize a standardized risk assessment for falls upon admission in addition to a tracking system that will monitor the occurrence of newborn falls. The statistics that would become available will help uncover the true prevalence of this issue. Further evidence-based practice is crucial in order to improve practice and make enhancements in the prevention of in-hospital newborn falls.
The creation of safe-sleep policies that utilize the AAP guidelines for SIDS prevention and safe-sleep environments will provide organizations with the foundational measures for ensuring proper safe-sleep environments to prevent newborn falls and promote newborn safety. Incorporating these measures in safe-sleep policies will help with standardizing practitioner care and consistent messages to all families with newborns.
The promotion of newborn safety is pivotal to all institutions who care for this population. Newborn falls are preventable injuries. The confounding variables involved in newborn falls are multifaceted. In order for newborns to remain safe, healthcare professionals must find a balance that supports nurturing, attachment, and bonding among caregivers and newborns along with the prevention of newborn falls. By utilizing existing evidence and expanding upon the current academic literature, researchers can begin to address this preventable injury.