Who should supervise children in a patient waiting area?

Q: Our laboratory has a lounge area for patients who are waiting for blood to be drawn. Most of the time the wait is not long, but like anywhere else, we can get backed up. Last week, there were two mothers with small children in the waiting area. When one mother was called in to have her blood drawn, she left her toddler in the waiting area. The child got into a tussle with one of the other children and bit him hard enough to break the skin. The mother of the second child is claiming it is our fault for not supervising the child or making the mother take him into the drawing area. Shes also demanding to have the offender tested for HIV. What is our responsibility?

A: To some extent, both your responsibility and your latitude in dealing with the situation will be determined by state law. This is a situation you need to pass on to your house counsel for management. Youll also want his direction in developing a policy of risk management for such incidents in the future.

In general, you cannot compel testing of any individual without consent, and you certainly cannot release medical information about the child without permission or the order of a court. 

Your efforts will be better directed toward risk prevention. Although it seems to be a matter of common sense that parents are responsible for their children, common sense is often in short supply these days. Given that this situation has arisen, and is likely to in one form or another again, you might wish to post a sign in your waiting area notifying parents that they are responsible for controlling their children at all times during their visit. Reinforce that message verbally when a patient checks in with small children in tow.

Most drawing areas are small and do not lend themselves to having a young child around while bloodwork is being drawn. Further, they abound in risks for inquisitive children who are not watched or restrained. I have received reports of small children getting into drawing supplies and breaking collection tubes, as well as reports of children managing to stick their hands into sharps containers. One physician was horrified when she went into an office exam room to see a patient only to find the child playing with syringes extracted from the supposedly safe sharps box on the wall next to the examining table while Mom sat placidly unaware of the situation, lost in her magazine. The same thing can easily happen in a phlebotomy setting.

Physical risks are not the only problem. Seeing blood drawn from a parent can be traumatic for small children and should be avoided when possible. It is wise to have a policy of excluding children from drawing areas whenever possible, and it should be possible most of the time.

The resolution is to ask that patients with small children bring along another adult to manage the children during the brief time that specimens are being collected. You may wish to advise referring physicians of this policy and to incorporate it into the standard instructions given to patients when they call to arrange appointments or inquire about testing. 

In todays world of working mothers and single parents, this is not always possible, and you have already experienced the reality of unsupervised children in your lounge. In such situations, its probably best to ask staff to be responsible for the child for a few minutes, although this carries with it risks as well. The likelihood of the child being injured is small, but assuming custody, even temporarily, means that the lab is potentially responsible for the childs welfare. It also means that the staff member is distracted from his usual work, interrupting the flow of work and compromising the overall function of the lab. Assuming care of errant children should be a last resort.

Perhaps more important is to take a look at your lounge area to insure that it is child-safe even when children are under the custody and supposed control of their parents. Outlets should be covered to prevent introduction of foreign objects. Because serious injuries, even death, can result from climbing on furniture, all tables, chairs, and credenzas should be stabilized to prevent tipping if a child decides to climb on it. Particular attention should be paid to refreshment areas that have coffee makers; it is remarkably easy for toddlers to upend a coffee maker and spill scalding liquid, or to put an unguarded hand on a warmer. 

Some institutions provide toys and books for the amusement of waiting toddlers. These have the advantage of occupying little minds, but can be turned into impromptu weapons. They can also be an avenue for transmission of infectious disease and inadvertent self-injury. Having toys around will require that you monitor them for structural safety and cleanliness.

Barbara Harty-Golder is a pathologist-attorney in Sarasota, FL. She directs the clinical laboratory at Health South Rehabilitation Hospital in Sarasota, and maintains a law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management, and human resources management.

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