CHA Checklist For Hospital Discharge Recommendations Safe Transportation Of Children

User Manual: CHA-Checklist-for-Hospital-Discharge-Recommendations-for-Safe-Transportation-of-Children

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CHECKLIST FOR HOSPITAL DISCHARGE RECOMMENDATIONS
FOR SAFE TRANSPORTATION OF CHILDREN
Children’s Hospital Association was part of the Expert Working Group convened by National Highway Traffic
Safety Administration that developed the recommendations. Other members of the working group and a link to
the recommendations are listed at the end of this checklist.

1. Develop a child passenger safety discharge policy based
on these recommendations and best practices.
2.		 Participation of the following areas should be considered:
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Nursing and medical staff
Risk management
Trauma services, emergency department, and
injury prevention center or program
Women’s hospital/obstetrics
Pediatrics
NICU
Marketing
Community outreach
Development
Administration
Human resources/education
Rehab – OT/PT
Case management/social work
Others as appropriate		

5b. Your policy should specify staff responsibilities, including
the individual(s) who will:
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6a. Preterm and Low Birth Weight Infants
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3.		 Your policy should explicitly state the following:
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The units and patients covered by the CPS policy
Which units house the CPS policies and programs
Which individuals are responsible for oversight
Which recognized cost center(s) will include CPS activities.
All staff and other resources should be appropriately and
accurately included in the budget
A regular cycle for review of policies and procedures

4. To manage risk, hospitals should provide for the following
when implementing their policies:
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Appropriate documentation
Consistent application of all policies
Appropriate staffing and training, a CPS Technician
is recommended
Appropriate referrals to outside resources
The inclusion of patient education (e.g., written materials) at
the time of admission with regards to the discharge policy

5a. Hospitals should specify the responsibilities of the health
care facility and providers. CPS Technicians/hospital staff
should provide education regarding best safety practices.
Final decisions are made by the parent or legal caregiver.
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Ensure proper documentation is used
Provide education to families and referral to community
resources
Provide car seat use and installation education and/or referral
(if necessary) to families
Provide guidance for management of non-compliant patients

Develop policy
Develop/review/obtain update materials for family education
Train other staff members. When available, it is preferable
that a certified Child Passenger Safety Technician Instructor
train staff about CPS
Assure the quality of policy implementation and programs

A hospital policy regarding Car Seat Tolerance Screening1
(CSTS), also sometimes referred to as Car Seat Tolerance
Testing, consistent with the American Academy of Pediatrics
clinical report “Safe Transportation of Preterm and Low Birth
Weight Infants at Hospital Discharge,” should state:
 Which staff conduct the test
 What training they should receive
 Equipment used for testing
 Importance of using the infant’s own car seat, placed
at the angle recommended by the manufacturer
 Length of time for which the car seat tolerance
screening is conducted
 Threshold values for considering a car seat tolerance
screening to have been “failed”
 How parents will be educated about the car seat
tolerance screening
 Need for follow-up testing for infants discharged in
car beds
 appropriate site for retesting
 when the retesting should occur

6b. Children with Special Healthcare Needs
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Appropriately trained staff for children with medical
conditions that involve special positioning requirements or
considerations for travel
When possible, defer safe transportation questions for children
with special healthcare needs to a CPS Technician with Special
Needs training; or, at a minimum, provide referral to resources
to families with children with special healthcare needs
Ancillary pieces of medical equipment in transit (e.g., walkers,
crutches, oxygen tanks, monitors), should be secured on the
vehicle floor; underneath a vehicle seat or wheelchair; or to
the bus seat, bus floor or bus wall below the window line

7. Your policy should specify the training and qualifications
necessary for staff involved in CPS activities. In general,
training and qualifications should be commensurate with
the level of involvement in family education; staff should
only perform the tasks for which they are trained. Specific
considerations include:

9. & 10. If a hospital provides (gives, sells, or loans) car seats
to families, we recommend the adoption of an policy
stating the following:
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A. Conducting the car seat tolerance screening:
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Define training and qualifications for conducting the screening
A CPS Technician with newborn or NICU experience should
position the infant in the car seat. Alternatives include
allowing staff or a parent who has received education from the
Technician to position the infant. If the hospital policy dictates
that a parent should position the child in the seat, also include
this information during admission
Specify who can educate families about how to properly place
their infant in a car seat
 Staff should receive angle tolerance testing training
 It is recommended that a CPST assist with the testing

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B.		 Other CPS activities

		 Staff members who are not CPS Technicians should:
 Refer families to community resources (e.g., local Technicians
and inspection stations),
 Provide verbal information about correct car seat use as
described in the American, Academy of Pediatrics policy
statement “Child Passenger Safety” and
 Distribute written educational materials to families
 Any additional tasks (e.g., providing hands-on education to
families, providing information not included in the AAP policy
statement) should only be performed by a CPS Technician
 Generally, CPS Instructors teach CPS Technicians and CPS
Technicians conduct education and hands-on training with
parents and families. CPS Instructors have more training and a
higher level of knowledge regarding CPS issues and practices
in the field

8.		 All hospitals should adopt policies regarding provision of
family education on CPS. Your policy should include:

A definition of the components of family education (e.g.,
education on transportation of infants, toddlers, and
preschoolers; education on use of booster seats and seat belts
for older children)
 Written educational materials that:
 Have been reviewed by a certified CPS Technician
 Are current and from the following nationallyrecognized organizations with CPS expertise:
1. National Highway Traffic Safety Administration (NHTSA)
							2. American Academy of Pediatrics (AAP)
							3. Safe Kids Worldwide
							4. Children’s Hospital of Philadelphia (CHOP)
							5. For children with special healthcare needs, please
see materials from the Automotive Safety Program,
Riley Hospital for Children at IU Health at
www.preventinjury.org
 A specified annual or biannual review cycle for educational
materials
 Should include a current list of CPS Technicians
employed by the hospital and available in the community
 A procedure for collecting, maintaining, and disseminating
current information on community resources including CPS
Technicians and car seat inspections stations.
 A responsible party should be indicated, and could be the
organization’s senior CPS Technician or CPS Instructor
 Staff who are not certified as CPS Technicians should refer
families to community resources

How to access the car seat
Eligibility criteria
How car seats will be checked for recall or expiration
How the hospital will ensure that the seat provided is
appropriate for the child’s age and size, per manufacturer’s
instructions
How the condition of the car seat will be ensured and
monitored (for loaner programs)
How car seats will be cleaned and processed for the next use
(for loaner programs)
That the instruction manual should always be provided with the
car seat
Procedures for documentation and inventory control (for
loaner programs)
Release of liability
That the parent must read and familiarize themselves with the
car seat manual
Whether families should be notified if the seat has been
previously used, and if so, how such information will be
provided (for loaner programs)

11. Hospital CPS discharge policy should reflect:

State CPS laws (if your hospital services multiple states,
describe how different state laws will be followed) State
CPS laws are often less rigorous than best practice
recommendations for car seat use. This information should be
shared with families during their education.
 AAP best practices
				http://pediatrics.aappublications.org/content/127/4/
788.full.pdf+html
 NHTSA best practices
					http://www.nhtsa.gov/ChildSafety/Guidance
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12. An incremental approach to policy development and
implementation increases the likelihood of success.
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Such an approach can be modeled on other hospital quality
improvement or performance excellence efforts; specific
metrics can be defined, monitored, and used to inform policy
and program refinement and expansion. The collection of
hospital-based data (e.g., number of emergency department
visits for motor vehicle crash-related injuries) is encouraged.

Source: Hospital Discharge Recommendations for Safe Transportation of Children: Best
Practice Recommendations developed by an Expert Working Group convened by National
Highway Traffic Safety Administration, March 25, 2014
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American Academy of Pediatrics
Children’s Hospital Association
National Child Passenger Safety Board
National Highway Traffic Safety Administration
National Safety Council

http://cpsboard.org/cps/wp-content/uploads/2014/04/FINAL_dischargeprotocol_2014_logos.pdf
These recommendations have been adapted into a checklist by Children’s Hospital
Association to use in the development or review of a discharge policy for safe transportation
of children. The recommendations have been lightly copy edited for clarity in a checklist
format. They have not been re-interpreted; however, they have been shortened in some
cases. Supporting text can be found in the original document.



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