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Infant abduction in Canada prompts a review of security best practices


Infant abductions from hospitals have become a rarity due in large part to increased security measures and greater awareness. But when an abduction does occur, it's a stark reminder of the potential risks that exist for healthcare facilities.

Infant abduction in Canada prompts a review of security best practices

After an infant was stolen in Quebec hospital, experts point to staff training and patient awareness

Infant abductions from hospitals have become a rarity due in large part to increased security measures and greater awareness. But when an abduction does occur, it's a stark reminder of the potential risks that exist for healthcare facilities.

For hospitals across the U.S. and Canada, that reminder came following an abduction on Monday, May 26 at the Centre Hospitalier Régional de Trois-Rivières in Quebec when, according to news reports, a woman dressed as a nurse took a baby from the mother's room and calmly walked out of the hospital, unimpeded, with the infant.

For many hospitals throughout North America, the case was a classic example of the potential that still exists for a crime that rarely occurs, statistically speaking. According to statistics released by the National Center for Missing and Exploited Children (NCMEC) in January 2014, infant abductions have dropped dramatically since NCMEC began tracking cases in 1983. There have been 132 total infant abductions in the U.S. from healthcare facilities since 1983, but only 22 have occurred since 2000. In 2012 there was a rash of four abductions?in all cases, the infants were recovered unharmed?but in 2011 and 2013 there were zero infant abductions recorded in healthcare facilities.

Although the numbers are a testament to the thoroughness with which healthcare facilities have addressed this problem, infant abductions are still a very real threat, says John Rabun, director of infant abduction response at NCMEC in Alexandria, Virginia.

"My worry, particularly in the U.S., is that because we have done such a good job collectively, there is now kind of a sense that we're cured," he says.

Don MacAlister, vice president of healthcare for Vancouver-based Paladin Security, the largest healthcare security provider in Canada, agrees that some healthcare facilities have relaxed when it comes to infant abductions, largely because they occur so infrequently. Most hospitals have implemented the recommended security measures such as controlled access to the maternity unit, security cameras at the entrance of the unit, and nursing stations designed with a clear line of sight. However, processes are often more critical than environmental design.

"We need to be really tight on the process, maybe tighter than ever, in terms of questioning people without ID, having really good communication to the parents, and training for our staff in recognizing odd behavior and recognizing the signs of potential risks," MacAlister says. "I don't want to say that wasn't in place [at Trois-Rivières], I'd rather say that's where we need to be careful that we're not slipping and taking for granted that we have these secure units."


Hardening the target

One of the primary ways that hospitals can prevent infant abductions is through frontline staff education and awareness. NCMEC analyzed the characteristics of 271 cases (from the hospital and home setting) between 1983 and 2011 and developed 10 common traits of the typical abductor (see checklist on p. 4).

"The simple stuff in terms of fixes is really making sure all of our people understand the profile, and they understand how this woman works," Rabun says.

Frontline staff members should also be aware that infant abductors often "window shop," typically visiting a hospital multiple times to determine what the security protocols are before attempting to take an infant, says Tony York, CHPA, CPP, chief operating officer of HSS, Inc., in Denver. He suggests incorporating this process of window shopping into drills so that nurses can get a better sense of what to look for and how to respond if they see a suspicious person on the unit. During drills, nurse administrators and security directors should look at what questions are being asked by the nurse, and how diligent and alert caregivers are to someone who is wandering around the unit.

"We want them to have that experience from that perspective," York says. "We want to see what it would be like if there is someone who has the desire to commit this heinous act, and what do we need to do about any opportunity for them to be successful here."


Educating parents

In addition to nurses, parents?particularly mothers?are often the primary line of defense in preventing infant abductions. As the recent case in Quebec demonstrates, abductors are almost never violent when taking an infant from a healthcare facility. Instead, they use deception as a tool to take the baby right from the mother's arms or from her room. For that reason, the hospital should make efforts to remind mothers that while abduction is a potential threat, just being aware of that threat is a simple step they can take to protect themselves and their baby.

This education should begin during prenatal visits and extend through postpartum care. Hospitals should have signage around the facility reminding mothers not to give their baby to a nurse they do not know.

Finally, reminders from the nurse during each change of shift will help drive the point home, even during a time when parents are often overwhelmed by the birth of their child. The message can be simple and succinct: "I am your nurse. This is my badge, which authorizes me to take care of your baby, and most importantly, I will let you know if there is anyone coming to care for your baby other than me."

"It doesn't have to be paranoid or scary, it's just novel that they know," York says. "What that says to mom is, 'I'm not giving my baby to anyone if Nurse Mary didn't tell me about it.' "


Security's role

In addition to coordinating infant abduction drills and developing infant abduction policies and procedures, security plays an important role in fine-tuning the physical layout of the unit and the specific prevention measures that are in place. NCMEC publishes a well-regarded self-assessment tool that hospitals can use to identify gaps in their infant abduction prevention program.

Generally, security departments are in charge of three primary areas, according to MacAlister: design, process, and response.

"I think security can take a lead role in understanding the needs of these three pieces and making sure the administration and folks that run these programs in hospitals are aware that there are such guidelines and they understand that this relates directly to how they protect newborns in hospitals," he explains.

In very basic terms, security needs to be available to respond to and handle any suspicious characters, Rabun says. Nurses are trained to listen to their gut instincts, and it's important that they feel comfortable contacting security if something doesn't seem right so officers can take the necessary precautionary steps.

"I think the single best thing security can do, besides getting cameras and electronics in place, is to make themselves accessible," he says.

Security departments should also be proactive in how they address suspicious people in the hospital, Rabun adds. Potential abductors will often go to multiple hospitals in the area, so it's particularly important that local security departments communicate with one another to identify suspicious characters. If there are common trends, and a suspicious person continues to come to the hospital, security should remove that person for trespassing, he says.

Twenty years ago, hospital CEOs never would have agreed to that approach, he notes. Now, although the chances of an infant abduction occurring are slim, the risk is far too great not to take a defensive approach.

"Hospitals are public places, but not really," Rabun says. "Get security and a nurse manager or risk management?at least two people from the hospital?to say to her, 'We don't know what is up, we're not accusing you, but we're not going to have people messing with our babies. If you are in need of medical attention for real, then come on back, or if you have a family member at the hospital, you'll be allowed. But for any other reason, if you step foot on our campus, we'll have you locked up for trespassing.' "

 The pros and cons of an electronic tagging system

Many in healthcare point to the technological advancements of infant tagging systems that have helped reduce the number of infant abductions, but hospital security experts caution against a heavy reliance on these systems.

"To be honest with you, I would rather not have an infant tagging system and instead be comfortable with the processes in place and the staff training and the other protective measures that are in place, including a response plan," says Don MacAlister, vice president of healthcare for Paladin Security, located in Vancouver.

In June, following an internal review, the Centre Hospitalier Régional de Trois-Rivières in Quebec announced that it would be purchasing and outfitting its newborn unit with an infant tagging system, after the facility experienced and thwarted an abduction in May.

John Rabun, director of infant abduction response at NCMEC in Alexandria, Virginia, agrees that these electronic systems are not the silver bullet for prevention. In fact, guidelines developed by NCMEC merely recommend that hospitals consider a tagging system; they make no suggestion that hospitals must install them. "I love electronic tagging, but there are hospitals I've been in and still go in where they would just as soon not have to put in electronic tagging," he says. "And because of their design and the way they function, as long as you considered it, you can make a case not to have it."

One of the frequent drawbacks to an electronic tagging system is the possibility of alarm fatigue, says Tony York, CHPA, CPP, chief operating officer of HSS, Inc., in Denver. If there are too many nuisance alarms, staff members will start to ignore them entirely, which defeats the system's intention.

"A system that is supposed to mitigate this risk has now actually become a liability because you have folks that aren't paying attention to it," York says. "Now they can't discern between what is real and what is not."

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