Preventing neonatal kidnapping
1
LETTERS Preventing neonatal kidnapping As my labor and delivery unit moved into a multimillion dollar labor, delivery, recovery, and post- partum facility with a high-tech in- fant security system, I received the January/February 1992 JOGNN and read the article, “Preventing Neo- natal Kidnapping.” My experience with the infant secutity system at our hospital has been most unsatisfactory. I object to the system because I do not be- lieve that this is the way to guaran- tee infant security. Beyond that, the inconvenience of the system is phe- nomenal. There has been no neona- tal kidnapping at this hospital since it opened its maternity service in the mid-1960s. Despite this, the alarms worn by the neonates are set off regularly by the elevators, by movement through the hallways, and when carrying neonates out of the nursery. Three neonates have been discharged without removal of the secutity device, because if you cover the device with enough blankets, it does not trigger the alarm. One incident has been identi- fied. While a mother slept, the fa- ther took the neonate with him to visit another mother on the floor. He thought he was being a good father, taking responsibility for the neonate and allowing the mother to sleep. The hospital called it an incident and believes it validates the use of our security system. Should I also mention that the device can be irritating to the neo- riod in which family-centered ma- ternity care was embraced by a large number of hospitals. Before this, access to the neonate was re- stricted for everyone, the mother and father included. The neonate belonged in the nursery and could visit the mother only when hospital policy deemed it appropriate. A crucial factor for setting the stage for neonatal kidnapping was the in- stitutional belief that the mother should relinquish her neonate to hospital personnel whenever they requested or demanded. Potential kidnappers would impersonate hospital employees to gain access to mothers and neonates. When visitation policies re- laxed, hospitals maintained control of the neonate. The mother was still expected to relinquish the neo- nate on hospital employee de- mand. I suggest that this practice puts neonates at risk for kidnap- ping, not the lack of staff vigilance or neonate security policies. Tight- ening visitation policies is a knee- jerk response to what the author admits could be an increase in re- porting rather than a rise in inci- dence. It also would be a step back from family-centered care. The author’s recommendation for identification of hospital per- sonnel and maintaining the privacy of all patients is important. But the most essential part of any neonate security policy should be the em- powerment of the parents in their responsibilities toward their neo- nate and their rights as parents. Elizabeth Stevens, RN, BSN Staff Nurse Labor, Delivery, Recovery, and Baystate Medical Center Springfield, MA Postpartum Unit JOGNN). I found the article inter- esting and well written, but it con- tained some misleading informa- tion. In discussing technical prob- lems under the section entitled “Nursing Implications,” the follow- ing sentences appeared: “Noise ar- tifact can be decreased by promptly silencing the ventilator, warming table, and cardiorespiratory moni- tor alarms. Nurses should talk in a soft tone in the nursery and remind coworkers and parents of the im- portance of reducing noise levels in the nursery.” This passage leads one to con- clude that pulse oximeters give in- accurate information in the pres- ence of audible noise. This is not so. The type of “noise” that creates problems for pulse oximeters is electrical, not audible noise. Stray electrical current from electrocau- tery devices and 60-cycle interfer- ence may cause problems. While I agree with Ms. Comer that it is de- sirable to minimize noise in the neonatal intensive-care unit, it is not because of the effect that audi- ble noise has on pulse oximeters. Rather, it is to minimize unneces- sary stimulation of our fragile pa- tients. Ms. Comer also discusses the technical problem of motion arti- fact. In order to understand this is- sue, it is important to have an appre- ciation of how a pulse oximeter makes pulse and saturation deter- minations. Pulse oximeters work on the principles of spectro- photometry and plethysmography. Simply put, oximeters look for a mechanical pulse signal, the ex- pansion and relaxation of the pe- ripheral vasculature with each heartbeat. Once that signal is ob- tained, the oximeter determines nate’s leg when it is tightened so the ratio of oxygenated hemoglo- bin to the total amount of hemoglo- that it does not fall off? The period in which there has I am writing about the article bin capable of carrying oxygen by been a significant rise in neonatal “Pulse Oximetry” by Diane M. using two discrete wavelengths of kidnappings coincides with the pe- Comer (January/February 1992 light. Pulse oximetry 350 JOGNN Volume 21 Number 5
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Transcript of Preventing neonatal kidnapping
L E T T E R S
Preventing neonatal kidnapping As my labor and delivery unit moved into a multimillion dollar labor, delivery, recovery, and post- partum facility with a high-tech in- fant security system, I received the January/February 1992 JOGNN and read the article, “Preventing Neo- natal Kidnapping.”
My experience with the infant secutity system at our hospital has been most unsatisfactory. I object to the system because I do not be- lieve that this is the way to guaran- tee infant security. Beyond that, the inconvenience of the system is phe- nomenal. There has been no neona- tal kidnapping at this hospital since it opened its maternity service in the mid-1960s. Despite this, the alarms worn by the neonates are set off regularly by the elevators, by movement through the hallways, and when carrying neonates out of the nursery. Three neonates have been discharged without removal of the secutity device, because if you cover the device with enough blankets, it does not trigger the alarm.
One incident has been identi- fied. While a mother slept, the fa- ther took the neonate with him to visit another mother on the floor. He thought he was being a good father, taking responsibility for the neonate and allowing the mother to sleep. The hospital called it an incident and believes it validates the use of our security system.
Should I also mention that the device can be irritating to the neo-
riod in which family-centered ma- ternity care was embraced by a large number of hospitals. Before this, access to the neonate was re- stricted for everyone, the mother and father included. The neonate belonged in the nursery and could visit the mother only when hospital policy deemed it appropriate. A crucial factor for setting the stage for neonatal kidnapping was the in- stitutional belief that the mother should relinquish her neonate to hospital personnel whenever they requested or demanded. Potential kidnappers would impersonate hospital employees to gain access to mothers and neonates.
When visitation policies re- laxed, hospitals maintained control of the neonate. The mother was still expected to relinquish the neo- nate on hospital employee de- mand. I suggest that this practice puts neonates at risk for kidnap- ping, not the lack of staff vigilance or neonate security policies. Tight- ening visitation policies is a knee- jerk response to what the author admits could be an increase in re- porting rather than a rise in inci- dence. It also would be a step back from family-centered care.
The author’s recommendation for identification of hospital per- sonnel and maintaining the privacy of all patients is important. But the most essential part of any neonate security policy should be the em- powerment of the parents in their responsibilities toward their neo- nate and their rights as parents.
Elizabeth Stevens, RN, BSN Staff Nurse Labor, Delivery, Recovery, and
Baystate Medical Center Springfield, M A
Postpartum Unit
JOGNN). I found the article inter- esting and well written, but it con- tained some misleading informa- tion.
In discussing technical prob- lems under the section entitled “Nursing Implications,” the follow- ing sentences appeared: “Noise ar- tifact can be decreased by promptly silencing the ventilator, warming table, and cardiorespiratory moni- tor alarms. Nurses should talk in a soft tone in the nursery and remind coworkers and parents of the im- portance of reducing noise levels in the nursery.”
This passage leads one to con- clude that pulse oximeters give in- accurate information in the pres- ence of audible noise. This is not so. The type of “noise” that creates problems for pulse oximeters is electrical, not audible noise. Stray electrical current from electrocau- tery devices and 60-cycle interfer- ence may cause problems. While I agree with Ms. Comer that it is de- sirable to minimize noise in the neonatal intensive-care unit, it is not because of the effect that audi- ble noise has on pulse oximeters. Rather, it is to minimize unneces- sary stimulation of our fragile pa- tients.
Ms. Comer also discusses the technical problem of motion arti- fact. In order to understand this is- sue, it is important to have an appre- ciation of how a pulse oximeter makes pulse and saturation deter- minations. Pulse oximeters work on the principles of spectro- photometry and plethysmography. Simply put, oximeters look for a mechanical pulse signal, the ex- pansion and relaxation of the pe- ripheral vasculature with each heartbeat. Once that signal is ob- tained, the oximeter determines
nate’s leg when it is tightened so the ratio of oxygenated hemoglo- bin to the total amount of hemoglo- that it does not fall off?
The period in which there has I am writing about the article bin capable of carrying oxygen by been a significant rise in neonatal “Pulse Oximetry” by Diane M. using two discrete wavelengths of kidnappings coincides with the pe- Comer (January/February 1992 light.
Pulse oximetry
350 J O G N N Volume 21 Number 5
