Preventing Postpartum Newborn Falls in the Hospital

As a Baby-Friendly Hospital, Cleveland Clinic’s Fairview Hospital encourages breastfeeding and bonding between mother and infant through close physical interaction. One challenge to these critical interactions, however, is ensuring the safety of the newborn. In the United States, there are approximately 600 to 1,600 newborn falls during postpartum hospitalization.

Sarah Tzvetkov, MSN, RNC-MNN, a clinical nurse on the unit, launched a newborn falls prevention initiative, beginning with a literature review to identify trends. “When I started my research, it was amazing how little had been done on this important topic,” says Tzvetkov.

Preventing newborn falls is important because not only can falls result in injury or even death of the baby, but falls can provoke feelings of guilt and shame in parents and caregivers. “One of the biggest pieces around this problem is the stigma,” says Nora Knipper, MSN, RN, Nurse Manager of Fairview’s Mother and Baby Unit. “If you as a mom drop your baby, you are embarrassed and maybe even afraid someone will take your baby away from you.”

Factors that contribute to newborn falls

Some factors that can contribute to newborn falls include the following:

• Parental sleep deprivation.
• A mother receiving narcotics for pain relief.
• A mother with a low blood count who may be susceptible to passing out.
• A mother with unstable ambulation after childbirth.
• A mother who has had an epidural and may be numb and weak in the legs.
• Co-sleeping in a bed or chair.
• Items in the path to the crib, such as IV poles and lines.

After studying the issue of newborn falls, Tzvetkov and Knipper worked collaboratively with a team of caregivers to create newborn fall prevention protocols. The team included clinical nurses from the Mother and Baby Unit and Fairview’s Birthing Center, a lactation and childbirth educator, pediatricians, neonatologists and a representative from the Quality Department. It also included the nurse manager from the Mother and Baby Unit at Cleveland Clinic’s Hillcrest Hospital, which also wanted to tackle the issue of newborn falls.

The team developed a comprehensive approach to falls prevention, including educational materials for parents and clinical decision-making tools for nurses.

Educational tools and risk assessment

Cleveland Clinic’s goal is zero newborn falls. Fall prevention initiatives begin on admission to the unit. Nurses review the following educational materials with parents and family:

• A welcome letter that includes safety interventions, such as using a crib when transporting the infant between the room and nursery, not carrying the infant while walking the halls, and never leaving the baby unattended.
• An infant safety pledge form that is signed by parents. The form includes interventions to keep the newborn safe from falls, such as avoiding co-sleeping and making sure the mom’s bed is lower than the level of the crib.
• “Keep Me Safe” signs in each room with infant safety reminders.
• A “Days Since” sign on the unit bulletin board. “When you enter the unit, there’s a sign that shows what safe sleep looks like and another displaying how many days since a baby was dropped on the unit,” says Knipper. “It’s a very powerful talking point.”

In addition, nurses assess the safety and risk factors for the newborn. They also assess the risk of mothers falling using the hospital’s Fall Minimization and Post Fall Care Adult Protocol. Nurses use their judgment to determine if parents and family members are absorbing the education provided.

“We give our patients so much information from the moment they come through the door on the Mother and Baby Unit,” says Knipper. “The bedside nurse needs to discern if the mom isn’t listening because she was in labor for 19 hours, pushed for three hours and ended up in a C-section. The patient may not be ready to hear key information. The nurse may have to come back again.”

Protocols for when a newborn falls

As part of the newborn falls initiative, the team also developed standard operating procedures for when a fall occurs. “In the past, there was no clear cut protocol for what to do with a baby that had just fallen,” says Tzvetkov. “We needed standardized procedures so that every baby receives the same care, even if the incident seems minor.”

Now, babies who fall are immediately taken to the newborn ICU for observation. Based on the findings, they may return to the Mother and Baby Unit or remain in the NICU for care. In addition, nurses complete a debriefing tool that includes factors that contributed to the event, pertinent background information, an assessment of the baby and a recommendation for care.

“We talk about falls very transparently with patients and families and display information prominently on the unit and in the rooms,” says Knipper. “That helps prevent falls.”