Journal clubPediatric Falls

Cheryl Stohler RN BSNUniversity of Central Florida

The Humpty Dumpty Falls Scale:

A case-control study

Hill-Rodriguez, D., Messmer, P., Williams, P., Zeller, R., Williams, A., Wood, M. & Henry M. (2009) JSPN 14 (1)

Why are Falls important?

Second most costly type of injury Largest single category of hospital inpatient

reports It has been estimated that an average ward will

have about 10 falls per month of which 30% cause some harm and 1–5% lead to serious injury

Joint Commission’s National Patient Safety Goals include the provision for patients and their families to report concerns about safety, including falls.

Falls are defined as any sudden, unintentional change in position that caused an individual to land at a lower level, on an object, on the floor, or on the ground.

A near miss is when a patient my lose his balance or

become weak and someone lowers him to the floor and an

Injury is defined as a disruption of an unplanned event requiring intervention.

What defines a Fall?

Inpatient falls can be classified into three categories

Accidental falls: such as environmental considerations (33%) Even with parents present 57% of the time

Anticipated physical/physiologic factors such as such as medications, post-op (61%)

Unanticipated physiologic falls unexpected events, such as syncope, seizure fractures (6%)

How are falls measured?

Incident reports in the acute care setting use the following ANA–NDNQI fall-related injuries categories:

(1) None indicates that the patient did not sustain an injury secondary to the fall. (2) Minor indicates those injuries requiring a simple intervention. (3) Moderate indicates injuries requiring sutures or splints. (4) Major injuries are those that require surgery, casting, further examination (e.g., for a neurological injury). (5) Deaths refers to those that result from injuries sustained from the fall

Evidence Based Research findings :Humpty dumpty StudyChildren at-high risk for falls (2.5%- 3.0% per 1,000 patient days)

Preschoolers (agers 19-24 months) Children under 10 are twice at risk for falls compared with the

total population Children with disabilities and minimal mobility Children in wheelchairs regardless of cognitive ability Males are 2:1 ratio for falls Diagnosis Respiratory/pulmonary/ENT #1/ Neurological #2 Those NOT within 24 hours post op Those who are NOT NPO More fell on a Monday, followed by Thursday Highest falls in October Falls related to equipment include tripping over equipment or

furniture, falls out of cribs or falls due to spills

Implication for nursing –for all patients: Bed in low position, rails up, brakes on Keep environment clear of excess equipment, furniture, personal

items Keep call light within reach Educate family of safety factors and to be extra diligent Assess elimination needs and offer assistance every 2 hours

accompany all children regardless of age/gender into bathroom. Assess oral intake needs and offer every 2 hours Use non-skid footwear for all patients Assess for adequate lighting Encourage parents to accompany child at all times

when ambulating Document in EMR so it shows in banner bar Document in education section parent/guardian education re: falls Post fall risk contract and explain team effort

Keep patient doors open at all times unless on isolation for all high risk patients

Apply “Fall Risk” bracelet on patient next to arm bracelet Document in EMR so it shows in banner bar Document in education section parent/guardian education

re: falls Post fall risk contract and explain team effort Post door sign outside patient room Assess need for 1:1 supervision. Consider moving patient closer to nurses station Hands-off bedside report

Additional consideration for high risk for falls

Application

WCH policy/procedure: Fall Prevention #6056

Additional category: Developmental fall: falls that are common to the child as they grow and develop. These falls are considered normal and are not reported unless they result in injury

Children under age 3 are to sleep in crib Once a patient is assessed and identified as high

risk for falling, they will remain on high risk fall precautions fro the length of the hospital stay.

Incident reports are used to record patient falls Falls are tracked per unit and hospital wide

What else can we do to decrease falls?Properly identifying patients at risk for falls ensures all disciplines, parents and visitors have awareness to prevent a fall.

Increased awareness results in less falls and injury due to these falls

Education to everyone helps improve patient/healthcare communication

We are a team in preventing falls!

THE END

References

Hill-Rodriguez, D., Messmer, P., Williams, P., Zeller, R., Williams, A., Wood, M. & Henry M. (2009) JSPN 14 (1)

Wolfson Children’s Hospital Policy and Procedure Manual : 2013