A New Scale for Evaluating the Risks for In-Hospital Falls of Newborn Infants: A Failure Modes and Effects Analysis Study

Table 2

Risk priority numbers determined before and after the preventive measures.

No	Risks	P	S	PF	RPN	Preventive Measures Taken	P	S	PF	RPN
12	The mother who is given patient-controlled analgesia (PCA) drops the baby when she stands up by herself while no one is near.	7	10	5	350	The mother is not allowed to move around by herself.; The mother is instructed not to pick up the infant while she is standing.; Her doctor is informed.; Support of a second person (nurse, accompanying person) is provided when the mother wants to hold the baby to breastfeed/care.	3	10	2	60
5	Infant may slip down from the hands of the doctor during delivery.	4	10	6	240	At vaginal delivery operations, before the delivery a thick towel is placed inside the cuvette of the obstetrical table in order to prevent the infant from falling.; After the infant is delivered, the assisting nurse cuts off the umbilical cord while the doctor holds the infant with the right technique.	2	10	2	40
8	After having the first medical examination (apgar scores and general condition fine) the newborn may fall due to turning over of the baby cot while it is being transferred to the baby room to be placed in the incubator in the operating room or in the baby cot in the delivery room.	6	10	4	240	The floor is inspected for dryness.; The safety of the equipments that will be used is checked before the transport; The baby should be not be hold in the arms, it should be transported by the incubator/cot.; When moved around, the cot must be held from the metal portion mounted on the main body (the bassinet portion that is not attached to the main body can slide during movement).; When the baby is transported from the cot/incubator to another place, the cot/incubator is held close and at the same level with the bed/equipment.; When an elevator is used during the transport of the baby, the height difference between the floors of the elevator and the flat should be checked (height difference may unbalance the cot, the cot may turn over and the baby can fall).	2	10	2	40
2	Birth may occur, by standing up and straining of the patient when the cervix is dilated 5 cm or more.	3	10	6	180	The mother is not allowed to get out of the bed if the cervix is dilated to 5-6 cm.; Particularly toilet and all the other needs of the patient are resolved in bed.; The expectant is observed by a NST monitor, and when she gets out of her bed the nurse takes notice and checks the patient.; The expectant is transferred to obstetrical table at the suitable phase of predelivery (before fetal head comes out of perineum).	1	10	2	20
13	During the day, the infant is taken to baby room by the baby nurse for checking vital findings, changing diaper, and doctor’s examinations.	5	9	4	180	The floor of the mother's room is kept dry.; Support of a second person is provided.; The floor of the baby care room is always kept dry.; Bathing of the baby is done in the bathtub of the baby care room.; The mother is informed about the falls risk.	2	9	2	36
10	The infant cared for and dressed is placed in the baby cot and handed to the mother.	4	10	4	160	The floor is inspected for dryness.; The safety of the equipments that will be used is checked before the transport.	2	10	1	20
						The baby should not be hold in the arms, it should be transported by the incubator/cot.
						When moved around, the cot must be held from the metal portion mounted on the main body (the bassinet portion that is not attached to the main body can slide during movement).
						When the baby is transported from the cot/incubator to another place, the cot/incubator is held close and at the same level with the bed/equipment.
11	The mother picks up the infant to breastfeed it. Risk factors regarding the mother are analyzed.	4	10	4	160	The mother is informed about the falls risk.; The mother/accompanying person is reeducated on the risks of falling (Most of the falling incidents occur at night and at dawn).; If the pain score of the patient is ≥4, she is not allowed to pick up the infant by herself.; The doctor of the mother is instructed.; The mother is allowed to pick the infant under supervision and support of a nurse.; The doctor of the infant is instructed.; The falling risk of the mother is evaluated by the “Adult Fall Scale”.; The mother is informed to ask for nursing support whenever she breastfeeds/cares/holds the baby.	2	8	2	36
7	The newborn may fall while it is taken to the newborn care unit for the first medical examination.	3	10	4	120	The baby is placed in the cot prepared before delivery, which has a sterile blanket in it, by the doctor, to prevent the infant from passing from person to person.; The doctor of newborn unit and the assisting infant nurse picks up the infant with the cot and take the infant to baby care unit taking the shortest way between the cot and the newborn care unit (open bed).	1	10	1	10
14	Blood sample of the infant is taken to test for phenylketonuria and/or bilirubin on the day of discharge.; While final preparations are being made the infant may slip down from the baby care unit.	4	9	3	108	It is not allowed to hand the baby on during care/examinations.; A safe working environment is provided.; The falling risk that may be caused by the connected equipments is prevented.; The floor is inspected for dryness.; The safety of the equipments that will be used is checked before the transport.; The baby should be not be hold in the arms, it should be transported by the incubator/cot.	1	9	1	9
15	After the mother is given the necessary instructions and while they are being discharged, the infant may slip down from the mother’s hands.	3	9	3	81	The safety of the equipments that will be used is checked before the transport.; The baby should be not be hold in the arms, it should be transported by the incubator/cot.; The mother/ relatives are warned about risks of falling.	2	9	1	18
6	Infant may slip down while the umbilical cord is cut.	2	10	4	80	Sufficient number of qualified personnel attends the delivery (An obstetrician, a neonatologist, a midwife or nurse, a baby nurse).	1	10	1	10
						After the infant is delivered assisting nurse cuts off the umbilical cord while the doctor holds the infant with the right technique.
						In deliveries performed by cesarean section, the infant is placed on a sterile cloth on the cesarean table and the cord is cut off by clamping. The cord is put in the cot next to the cesarean table by the assisting nurse. The doctor of the newborn unit takes the infant with the cot and places it in the newborn baby care unit. (While taking the infant from the cot to the newborn care unit, the doctor takes the shortest way).
9	The infant may slip down from the hands of the nurse while it is being transferred to the baby care room in an incubator or baby cot to baby care room.	4	10	2	80	The floor of the mother's room is kept dry.; Support of a second person is provided.; The floor of the baby care room is always kept dry.; The safety of the equipments that will be used is checked before the transport.; The baby should be not be hold in the arms, it should be transported by the incubator/cot.; When moved around, the cot must be held from the metal portion mounted on the main body (the bassinet portion that is not attached to the main body can slide during movement).; When the baby is transported from the cot/incubator to another place, the cot/incubator is held close and at the same level with the bed/equipment.	2	10	1	20
3	Patient may give birth in the preparation room before the doctor arrives.	2	9	4	72	The doctor of the patient is informed as soon as the patient is admitted to the service.	2	9	1	18
4	Birth may occur while the patient is being transferred to the delivery room.	2	7	4	56	As soon as the patient is admitted to the service, preparations are started.; The doctor of the patient is informed.; The expectant is transferred to obstetrical table at the suitable phase of pre-delivery (before fetal head comes out of perineum).; Attendants are called.	1	7	1	7
1	Patient is admitted to the service to be prepared for the delivery.	2	4	2	16	The patient admitted for delivery is immediately directed to the service.	1	4	2	8

P: Probability of detection of an existing effect; S: Severity of effect; PF: Probability of failure; RPN: Risk priority number.