Learning From Quality Improvement Initiatives for In-hospital Newborn Falls Prevention From a Sleeping Mother: A Literature Review.

Abstract

Newborns experiencing skull fractures and brain bleeds after a fall from a slumbering mother generate a clinical crisis necessitating urgent resolution. Studies spanning 15 years inferred newborn falls from a sleeping mother as preventable, although aggregate data contradict this conclusion. An analysis of the literature identifies impediments to progress and ramifications for quality improvement leaders.