Work as a team to identify maternal and environmental risks.
- Nurses can identify risk factors for infant falls and proactively intervene and reverse risky scenarios.
- Nurses can lead non-nursing personnel to assist in preventing infant falls and educate parents about how to avoid infant falls.
- Nurses must respond to inherent risks with evidence based maternal-newborn care initiatives.
EVERY YEAR in the United States, 600 to 1,600 newborns experience an in-hospital fall, resulting in injuries that include bruising, abrasions, skull fractures, subdural hematoma, accidental suffocation, and death. Many parents and healthcare workers suffer emotional distress as a result. All healthcare employees who work with parents of newborns can contribute to infant safety by being aware of fall risks and helping to prevent them.
Contemporary postpartum care
Close interaction between newborns and families is standard practice. Babies stay in a bassinet in the mother’s room, breastfeeding is encouraged, and skin-to-skin time is promoted. These evidence-based best practices result in a less-stressful transition from fetal to newborn life and promote stable infant respiratory function, glucose measures, and temperature.
These widely applied practices also can lead to infant safety risks, especially when exhausted new mothers eager to comply with recommended practices don’t feel empowered to ask for assistance or time away from the baby. Nurses must identify the risks associated with these initiatives and educate staff and parents about best practices that balance infant/mother bonding with the mother’s need for rest and safe infant care.
Infant fall risks and consequences
In a recent study at Texas Health Resources, nurse scientists found that healthcare workers (including non-nursing personnel working on maternity units, such as housekeepers, dietary workers, chaplains, social workers, administrators, and admissions personnel) weren’t familiar with the term “infant falls.” (See Defined: Infant falls.) And some maternity nurses believed the issue was addressed with safe sleep practices, which are well represented in the literature and implemented in the mother-baby setting. Infant falls, however, receive much less attention. According to Hodges and Gilbert, no longitudinal studies of children who’ve experienced infant falls have been conducted, so we don’t know the long-term consequences.
The American Nurses Association National Database of Nursing Quality Indicators defines infant falls as a:
“fall in which a newborn, infant, or child being held or carried by a healthcare professional, parent, family member, or visitor falls or slips from that person’s hands, arms, lap, etc. This can occur when a child is being transferred from one person to another. The fall is counted regardless of surface on which child lands (e.g., bed, chair, or floor) and regardless of whether the fall results in injury. Falls in which a child rolls off a bed, crib, chair, or table count as falls.”
This definition doesn’t include falls resulting from faulty equipment or healthcare professionals’ safety violations, so those falls aren’t counted in the database.
Infant fall prevention starts with identifying the risks. A review of the literature and hospital safety reports indicates that infant fall risks include a variety of maternal characteristics and environmental factors. (See Infant fall scenarios.) Maternal risks include fatigue, preexisting conditions, and lack of awareness. Environmental risks include lack of mother-child supervision, bed and bassinet position, and obstructed walkways. (See Know the risks.)
These infant fall incidents have been reported in hospitals. When you see similar situations, take action to help prevent a fall.
• Mother falls asleep while breastfeeding and the baby slips between the mattress and side rail.
• Father who’s holding a baby bends over to retrieve a pacifier from the floor and the baby falls out of his arms.
• Father who’s asleep in a chair with the infant on his chest is startled by hospital sounds and reflexively jostles the baby off his chest.
• Mother with twins on a nursing pillow turns to place one twin in the bassinet and the other rolls off the pillow.
• Mother trips an obstacle while walking with the baby.
• Mother drops the baby when transferring him or her into the bassinet because it’s too far away.
• Bassinet and
When families are aware of the risks and nurses and other hospital staff closely monitor for them and intervene, infant falls can be avoided.
Nurses can educate all hospital personnel and families of their shared responsibility to report infant fall risks. Even in organizations without education support, personnel can substantially decrease infant fall rates by using Joint Commission recommendations, which include seven steps to guide prevention:
• Develop an assessment tool to identify those at risk. Establish a common language so that everyone performs assessments the same way.
• Use the formal assessment to tailor parent education and advise those at highest risk to call for help when they’re tired.
• Round hourly to help tired mothers or other caregivers place infants in bassinets.
• Promote maternal rest.
• Create a patient room sign or crib card for those at high risk of infant falls.
• Develop a standardized infant fall reporting and debriefing tool to record important data, which will help the organization understand risks and promote consistent post-fall infant care.
• In the event of a fall, provide emotional support to the family or any involved healthcare personnel who may suffer emotional distress.
All hospital personnel who interact with mothers and babies should be familiar with maternal and environmental risk factors. Encourage anyone who enters a mother-baby room to identify and report risks. (See Infant fall prevention is a team sport.)
Infant fall prevention education should continue at discharge. Beyond standard safe-sleep information, educate families verbally and in writing about maternal and environmental risk factors at home. For example, remind families that in the excitement of having a new baby they may underestimate their level of fatigue. Encourage mothers to ask for help with the baby to avoid exhaustion and to rest when the baby sleeps. Instruct mothers who take pain medication or other substances that may cause drowsiness or impaired judgment to ask for assistance with the baby. Families should insist that anyone caring for the baby be fully alert and focused on safety. Advise families to report all infant falls to their provider and follow up with an examination.
Seven hospitals within the Texas Health Resources network in Dallas–Fort Worth sought to increase healthcare providers’ knowledge and awareness of in-hospital infant fall risks. A project team that included labor and delivery and mother-baby unit direct care nurses and nurse leaders, two nurse scientists, a system education consultant, and corporate branding personnel created an evidence-based online learning module to teach all employees (housekeepers, dietary workers, chaplains, social workers, administrators, admissions personnel, nurse’s aides, and nurses) who have contact with mothers and infants about infant fall prevention to reduce the organization’s infant fall rate.
The modules addressed the scope of the infant fall problem, maternal and environmental risk factors, and steps to take when risks are identified. Quantitative pre- and post-survey data showed that participants (214 total) increased their knowledge of infant fall risk factors in hospital settings and improved their confidence to know what to do if they witnessed risks. For example, before education, 72% reported they could list three risk factors for infant falls, compared to 95.8% after. Similarly, the percentage of those who noted they knew what to do if they identified risk factors for an infant fall rose from 74% to 94.2%. Qualitative data showed that participants gained a clearer and deeper understanding of what situations may put infants at risk for falls. Par ticipants also said they were more likely to report a risky situation to the assigned nurse or initiate a risk prevention activity.
Nurses who are well-informed about the harm of infant falls can identify maternal and environmental risks and implement prevention strategies. They also can guide other hospital personnel to identify and report risks. A team approach to infant fall prevention helps protect newborns from harm.
Jo Nell Wells is a nurse scientist at Texas Health Harris Methodist Hospital Alliance in Fort Worth and a nursing professor at Texas Christian University in Fort Worth. Patricia Newcomb is a nurse scientist at Texas Health Resources in Arlington. Marta Schweit zer is a staff nurse at Texas Health Fort Worth-Alliance Hospital.
Hodges KT, Gilbert JH. Rising above risk: Eliminating infant falls. Nurs Manage. 2015; 46(12):28-32.
Joint Commission, The. Quick Safety: Preventing Newborn Falls and Drops. March 2018. jointcommission.org/assets/1/23/Quick_Safety_Issue_40_2018_Newborn_falls_drops.pdf
Lipke B, Gilbert G, Shimer H, et al. Newborn safety bundle to prevent falls and promote safe sleep. MCN Am J Matern Child Nurs. 2018;43(1):32-7.
Staggs VS, Davidson J, Dunton N, Crosser B. Challenges in defining and categorizing falls on diverse unit types: Lessons from expansion of the NDNQI falls indicator. J Nurs Care Qual. 2015;30(2):106-12.
Wallace SC. Balancing family bonding with newborn safety. Pennsylvania Patient Safety Advisory. 2014;11(3):102-08.
“Baby friendly”, as most nursing management define the term is the infant rooms in with the parents for the entire hospital stay. This means there are no opportunities for parents to receive rest. The term “Baby friendly” means no newborn nursery. All testing is done in the parents room and usually during the hours of 11 pm to 7 am. Breastfeeding must be every 2 hours for 10 to 20 minutes of latch time this doesn’t include the time required to check and change a diaper, positioning, stimulating the sleepy infant to latch and suck/swallow, etc. Nightshift personal become frustrated trying to help fatigued parents get the rest they need. Nurses have to battle reproachful management for taking infants out of an unsafe environment without documentation that paints the parents as neglectful rather than simply exhausted. It is appalling how the term “Baby Friendly” has been used and abused to bully new parents and nurses into creating an environment that is the farthest thing from “baby friendly”.
Spot on! And the new Baby Friendly standards are even worst. Our hospital never had falls before this initiative
we should have a nursery to watch baby when mom is tired.