Addressing in-hospital "falls" of newborn infants.

BACKGROUND: During postpartum hospitalization, close physical interactions between mother and newborn facilitate attachment, breastfeeding, and relationship competence. The challenge during this time is to support these important interactions in the hospital while ensuring the safety of the newborn. A literature review indicated that newborn "falls" and drops--collectively referred to as falls-remains largely unaddressed. Experience of a seven-hospital system in Oregon offers a template for understanding how and why infant falls occur in hospitals and how to address the issue. IDENTIFYING THE PROBLEM: For a two-year period (January 2006-December 2007), a query of a live voluntary event database yielded 9 cases of newborn falls (from 22,866 births), for a rate of 3.94 falls per 10,000 births. RESPONDING TO NEWBORN FALLS: A newborn falls committee made preliminary recommendations for interventions to reduce newborn falls, including (1) expanding thel patient safety contract, (2) monitoring mothers more closely, (3) improving equipment safety, and (4) spreading information about newborn falls within the state and throughout the hospital system. For example, staff use the patient safety contract to improve awareness and prevention of falls. The mothers and significant family members are asked to review the safety information and sign the contract. CONCLUSION: Newborns experience in-hospital falls at a rate of approximately 1.6-4.14/10,000 live births, resulting in an estimated 600-1600 falls per year in the United States. Additional reports of rates of newborn falls are urgently needed to determine the true prevalence of this historically underreported event. Standardized evaluation and management guidelines need to be developed to aid the clinician in the appropriate care of newborns experiencing this infrequent event.

Accuracy of different temperature devices in the postpartum population.

OBJECTIVES: To determine if different temperature monitoring devices routinely used in postpartum mothers and newborns provide similar temperatures and to compare the rectal and axillary routes for temperature monitoring in newborns. DESIGN: A method comparison design with randomization of the temperature device sequence was used to evaluate the level of agreement between the 3 different types of thermometers used. SETTING: A Level 3 (high risk) postpartum unit with 6,200 deliveries per year in a 450-bed, not-for-profit hospital in the Pacific Northwest. PARTICIPANTS: A convenience sample of 36 mothers and 36 newborns were studied during a 96 hours postpartum period. METHOD: Comparison of 3 different temperature devices (2 different electronic temperatures devices and a disposable temperature device) in mothers and newborns; comparison of different routes for temperature measurement in newborns (rectal, axillary). RESULTS: Statistically significant differences were found between the rectal and axillary temperatures obtained with the same electronic temperature device in newborns. In mothers, there was a statistically significant difference in oral temperatures obtained with the disposable temperature device and 1 of the electronic thermometers. CONCLUSIONS: The statistically significant temperature differences between the axillary and rectal routes in newborns using the same temperature device emphasize that axillary temperatures are not similar to rectal temperatures in newborns.