Car Seat Mis-use at Work

I work at a children's hospital and frequently see horrific car seat use when infants (usually siblings) are coming in in bucket seats. For e.g., yesterday a family came in and the patient's little brother was in his infant seat bundled up tightly in a thick plushy blanket (arms and legs firmly bundled in), the harness loosely buckled around him, and the chest clip as low as it goes. I am naturally assuming that he rode in the car like this and that they didn't bundle him/adjust everything to take him out of the car (heated underground parking attached to the hospital). It wasn't my patient this time and I am not a tech so I looked in horror as they walked by me, but kept my mouth shut.

If you were in my position, would you say something to the parents? Since I am not a tech, I'm not sure that I have the right to comment, but some of it is truly appalling. At the other hospital that I work at (primarily with newborns) we HAVE to do a car seat check before the patient can be discharged to ensure that the straps pass the pinch test and the chest clip is at the proper level (if they are leaving in a bucket seat). The children's hospital doesn't have this rule though and I'm sure that the mass majority of staff has no idea what to even look for if they were to look at a car seat. It is probably for the better that they aren't trying to check all of them as inappropriate information may be given out.

From a parent's perspective, if you had a nurse pointing out that your child wasn't buckled in safely, would you be receptive? If you were me, would you say something? Maybe I should just become a tech so that I can back myself up.

I'm a tech and I would NOT say anything

But I think you should become a tech. LOL

I don't think I would say anything to the parents. I might talk to hospital admin and see about getting some techs on staff or at least some info that can be handed out.

But as a parent, if a nurse gave me unsolicited advice about a topic that they may or may not be an expert on.....how I took it would honestly depend on how the nurse handled it and what my current mood was.

The hospital budgets are already very tight so I know that there is no way that getting a tech on staff would ever be approved.

I only say something so far if the parents flat out ask me; like show up to pick their baby up from the hospital for the first time if they have had medical issues since birth and have no idea how to even begin with putting their child in a car seat...I'd hate to see how it gets installed in the car though. I have had a few parents ask other questions as well about car seat use, like what position the handle needs to be in, and I tell them to refer to their manual.

I suppose I will just continue watching in horror but keep my thoughts to myself unless someone directly asks for basic help. Other than chest clip position, harness position (i.e. not having the child's legs over the harness part that is suppose to go around the hips), and harness tightness, I don't go much further since once again, not a tech, and I don't want to accidentally give out bad advice.

Generally when patients are being admitted, parents are stressed out and being told that they are doing something wrong is probably the last thing that they want to hear. On my other unit though, I have never had a parent get upset with me when I mention that we like to do a quick check once the child is buckled into the car seat to ensure that the harness is tight enough, which is almost always followed by me pointing out that it needs to be a bit tighter and showing them what the pinch test is.

On the unit that does check car seats, we have pamphlets, but not on the one at the children's hospital (on my particular unit at least). If we did, I would probably just sneak one into the welcome package that we give all of the families (assuming that the information is accurate and up-to-date).

bubbaray said:

But I think you should become a tech. LOL

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haha I figured that that was the response that I would get.

What about getting your supervisor to pay for you getting certified? No additional staffing costs, only the cost of the class and your time there during the class.

What about a flyer with the discharge paperwork?

4boysmom said:

What about a flyer with the discharge paperwork?

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That is a fantastic idea!

I'd refer them to a tech "I see you haven't had your carseat checked yet, here is who to contact"

Our state requires that car seat information be given to parents of children before or at discharge- but they only require that the information cover the requirements of the state's laws. I've seen everything from a bare minimum summary to really good comprehensive information, and everything in between. I think you could make a case for really good comprehensive information being given to your patients at discharge, and there are even pre-made flyers available for this purpose. "The Perfect Gift" pamphlet from SBS would be an appropriate one to order, or they have printable reproducible sheets if your budget needs to be just copying paper that go over the basics of seat selection and proper use for each age and stage.

I'm in a similar situation was was planning to make a post here about it too...
I just started working in a NICU and was told that we are NOT to give carseat advice whatsoever. We have to refer them to their manual for all questions. We do the carseat test before discharge and that's it
I'm planning on becoming a tech, hopefully then I'll be able to have a bit more freedom to educate the parents or at least make/distribute pamphlets about proper and legal use....
Best of luck to you, keep us updated if you make any headway...I could use some tips lol

You can get USAA booklets for free and have a stack of them at the nurse's station if your supervisor is OK with it.
I don't love the USAA booklets because they're like anti-ERF after age 2 (specifically says children over two must be FF) but other than that they're quite good.
It might give you opportunities to steer parents toward them rather than making them feel targeted. Like, "Oh, did you get one of these? They're free and we try to make sure all parents go home with one."

Brigala said:

You can get USAA booklets for free and have a stack of them at the nurse's station if your supervisor is OK with it.
I don't love the USAA booklets because they're like anti-ERF after age 2 (specifically says children over two must be FF) but other than that they're quite good.
It might give you opportunities to steer parents toward them rather than making them feel targeted. Like, "Oh, did you get one of these? They're free and we try to make sure all parents go home with one."

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OP is Cdn.

bubbaray said:

I'm a tech and I would NOT say anything

But I think you should become a tech. LOL

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I also think you should become a tech, you're in the perfect position to educate people. I do not think you should say anything until you are a tech, as people can get touchy about these things and then you're just another mother telling them what they're doing wrong...

I think once you are a tech you should say something even if it's very simple. "Oh, I'm a tech and you need to...b/c it's so much safer" Just pick the worst thing they're doing wrong and then wait for a response before adding anything else...

tam

AuntieKatie said:

I'm in a similar situation was was planning to make a post here about it too...
I just started working in a NICU and was told that we are NOT to give carseat advice whatsoever. We have to refer them to their manual for all questions. We do the carseat test before discharge and that's it
I'm planning on becoming a tech, hopefully then I'll be able to have a bit more freedom to educate the parents or at least make/distribute pamphlets about proper and legal use....
Best of luck to you, keep us updated if you make any headway...I could use some tips lol

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I work in the NICU too and we aren't supposed to buckle the base into the car but we are allowed to show them how to properly place the baby in the seat, positioning of harness, etc.

Last week when one of the nurses told parents that the straps on their seat really needed to be just a tad lower, the dad was planning to take a hammer and screw driver to the seat. Ugh. The nurse told him to check the manual to see if they would go lower (Baby Trend with the knob to adjust) and after studying the manual he decided the best way was to pry a bolt out of the back and chisel through the molded slots on the back. Yikes! This is when I refuse to keep quiet. I explained that he can't modify the seat, that it wouldn't be safe. The scary thing is that he really didn't seem to get why it was a problem!

On a positive note, our unit is sending 2-3 of us to get certified in February I'm so excited!

MoreLatte said:

I work in the NICU too and we aren't supposed to buckle the base into the car but we are allowed to show them how to properly place the baby in the seat, positioning of harness, etc.

Last week when one of the nurses told parents that the straps on their seat really needed to be just a tad lower, the dad was planning to take a hammer and screw driver to the seat. Ugh. The nurse told him to check the manual to see if they would go lower (Baby Trend with the knob to adjust) and after studying the manual he decided the best way was to pry a bolt out of the back and chisel through the molded slots on the back. Yikes! This is when I refuse to keep quiet. I explained that he can't modify the seat, that it wouldn't be safe. The scary thing is that he really didn't seem to get why it was a problem!

On a positive note, our unit is sending 2-3 of us to get certified in February I'm so excited!

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Yikes that is scary! I have thankfully never had a family try to take a screwdriver/hammer to their car seat! If they don't know how to adjust it, they often will just stand there puzzled and go "you do it", in which case, I show them how to adjust it but have them do it. I once had a family come to pick up their 3 month old twins (they were very premature so finally got to go home) with two car seats in boxes and puzzled looks on their faces. I had dad fish out the manual and gave him some time to read it before sending them home.

That is awesome that your unit is sending a few of your to get certified. :thumbsup:
I'm not sure if my manager at the children's hospital would be up for that since our patient population is only probably 10% babies, but I wonder if my unit at the other hospital would consider it since they expect us to help with car seats and about 90% of our patients are babies (generally NICU overflow or jaundice babies so primarily newborns). I might just go do it eventually on my own so at least I have something to back myself up when I am being asked for help.

You all have gave some wonderful suggestions! It's a shame that there is so much mis-use out there.

jacqui276 said:

That is awesome that your unit is sending a few of your to get certified. :thumbsup:
I'm not sure if my manager at the children's hospital would be up for that since our patient population is only probably 10% babies, but I wonder if my unit at the other hospital would consider it since they expect us to help with car seats and about 90% of our patients are babies (generally NICU overflow or jaundice babies so primarily newborns). I might just go do it eventually on my own so at least I have something to back myself up when I am being asked for help.

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Do they not see a liability issue if they are expecting you to help with car seats without being trained to do so? I might present it to them as a liability issue, and point out that certification with CPSAC comes with liability insurance for you.

Pixelated said:

Do they not see a liability issue if they are expecting you to help with car seats without being trained to do so? I might present it to them as a liability issue, and point out that certification with CPSAC comes with liability insurance for you.

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It's funny that you mention that because we have to be certified in so many different things for that exact reason when providing medical care yet they don't seem to have an issue with the whole car seat thing. I may have to have a chat with management and bring that point up.

I can't even imagine thinking it would be ok to chisel the plastic to make the straps lower! Some people just weren't blessed with common sense I guess.

When I had my baby in March, they did a test fit to see if he was good in it and told us that we should be able to stick 2 fingers under the harness. Once we were ready to be discharged, the nurse walked us out and watched us put him in the car and we were gone. I still do the trusty pinch test though!

It kills me to see some kids in carseats. One of my moms coworkers has a baby a few months older than mine and her carseat base was so wiggly! You could pick it up a few inches from the seat of the car. We were talking one day and I tightened it for her since she saw how tight mine was. That made me feel a lot better.