A System-Wide Hospital Child Maltreatment Patient Safety Program.

BACKGROUND AND OBJECTIVES: Hospital-wide patient safety programs have been used to ensure appropriate provision of care. Similar approaches have not been widely applied to child maltreatment. In this study, we describe a hospital-system child maltreatment safety program by characterizing the frequency of patients needing further intervention, associations between the age of patient and location of care and need for further intervention, and patients who require immediate intervention. METHODS: For all staff concerns for child maltreatment, a social worker completed a patient at risk (PAR) form. All PAR forms were reviewed within 24 hours by the child abuse team and categorized on the basis of 6 types of interventions, most significantly an "immediate callback." Wilcoxon rank and χ2 tests were used for group comparisons. RESULTS: Over a 30-month period, program interventions occurred in 2061 of 7698 PARs (26.8%). The most common reason for a PAR form was physical abuse (32.5%). Subjects requiring an intervention were no different in age than those who did not (median age: 5.6 vs 5.2 years). PAR forms performed in the emergency departments or urgent care were more likely to require an intervention than inpatient (odds ratio: 4.4; 95% confidence interval 3.6-5.3) or clinic (odds ratio: 2.0; 95% confidence interval 1.7-2.3) PAR forms. Of the 53 immediate callbacks, potential diagnostic errors and safe discharge concerns occurred in nearly one-half, and >40% involved subjects with bruising. Immediate follow-up in the child abuse pediatrician clinic occurred in 87% (46 of 53) of cases, resulting in a new or changed diagnosis in 57% of such cases. CONCLUSIONS: A child maltreatment safety program encompassing a health system can identify and address medical errors.

Building a Safe and Healthy America: Eliminating Corporal Punishment via Positive Parenting.

corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.

Staff Responses When Parents Hit Children in a Hospital Setting.

OBJECTIVE: Physical punishment of children is a prevalent practice that is condemned by most medical professionals given its link with increased risk of child physical abuse and other adverse child outcomes. This study examined the prevalence of parent-to-child hitting in medical settings and the intervention behaviors of staff who witness it. METHOD: Staff at a children's medical center and a general medical center completed a voluntary, anonymous survey. We used descriptive statistics to examine differences in the experiences of physicians, nurses, and other medical staff. We used logistic regression to predict intervention behaviors among staff who witnessed parent-to-child hitting. RESULTS: Of the hospital staff who completed the survey (N = 2863), we found that 50% of physicians, 24% of nurses, 27% of other direct care staff, and 17% of nondirect care staff witnessed parent-to-child hitting at their medical center in the past year. A majority of physicians, nurses, and other direct care staff reported intervening sometimes or always. Nondirect care staff rarely intervened. Believing staff have the responsibility to intervene, and having comfortable strategies with which to intervene were strongly predictive of intervention behavior. Staff who did not intervene commonly reported that they did not know how to respond. CONCLUSION: Many medical center staff witness parent-to-child hitting. Although some of the staff reported that they intervened when they witnessed this behavior, the findings indicate that staff may need training to identify when and how they should respond.

Medical center staff attitudes about spanking.

Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2580 staff at a large general medical center and 733 staff at a children's hospital completed an online survey; respondents were roughly divided between staff who provide direct care to patients (e.g., physicians, nurses) and staff who do not (e.g., receptionists, lab technicians). Less than half (44% and 46%) of staff at each medical center agreed that spanking is harmful to children, although almost all (85% and 88%) acknowledged that spanking can lead to injury. Men, staff who report being religious, and staff who held non-direct care positions at the medical center reported stronger endorsement of spanking and perceived their co-workers to be more strongly in favor of spanking. Non-direct care staff were more supportive of spanking compared with direct care staff on every item assessed. All staff underestimated the extent to which their co-workers held negative views of spanking. If medical centers and other medical settings are to lead the charge in informing the community about the harms of spanking, comprehensive staff education about spanking is indicated.

Implementing safe sleep practices in a neonatal intensive care unit.

OBJECTIVE: Sudden infant death syndrome (SIDS) remains the leading cause of death in the postnatal period. Accidental suffocation and strangulation in bed deaths have quadrupled. The American Academy of Pediatrics (AAP) expanded its back to sleep recommendations to include a safe sleep environment. The AAP makes recommendations to healthcare professionals to model safe sleep practices and educate families on SIDS reduction strategies. The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment. METHOD: The NICU Safe Sleep policy was revised to include AAP updated recommendations. Educational updates were provided to staff. A safe sleep packet with a video was created for and shared with families. Wearable blankets were implemented. A safe sleep observation checklist was created. Baseline data and post-education random observations data were collected and shared with staff. RESULTS: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%. CONCLUSIONS: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

Duodenal hematoma from a fall down the stairs.

Blunt abdominal trauma is not a common finding in abused children. However, there is a high rate of mortality associated with this type of injury. Recognizing the presentation of a child with abusive abdominal injuries is crucial for healthcare providers. Often these children are too young to provide a history of the injury, the caretaker accompanying the child may provide you with a misleading history or a history of minor trauma, and the child's symptoms may range from abdominal pain to vomiting to septic shock, making the diagnosis difficult. The child's anatomy puts him/her at risk for intra-abdominal injury from blunt force. They have less musculature and fat than adults and their rib cage is horizontally oriented, allowing organs to extend beyond the costal margin. Duodenal injuries are extremely uncommon in children because of the retroperitoneal location and a substantial amount of force is necessary to injure this area of abdomen. Understanding the different injury patterns and various mechanisms required to cause abdominal injury is important in determining accidental injury from nonaccidental injury.