Paediatric Falls Risk

Assessment & Prevention

Strategy

Education Module

March 2012

Reviewed May 2016

Kristen Dove

Donna McAnallen

1

Why Assess for Falls?

Falls are:

A major patient safety risk as identified by Accreditation Canada

The leading cause of death among older adults

The leading cause for injury admissions to Ontario Acute Care Hospitals

Falls account for up to 84% of inpatient incidents

Fall injuries pose a significant burden in terms of loss of life, reduced quality of life and economic cost

RNAO

http:www.rnao.org/Storage/26/2035_168_Falls_Self-Learning Package_FINAL.pdf

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Paediatric Falls

Rates are typically less than adult rates; however, medication use, a new environment, and underlying medical conditions may increase a child’s risk for falling in hospital

An increasing number of procedures occur in the ambulatory areas, further increasing a patient’s fall risk i.e. procedural sedation

3

Types of Falls

Paediatric Falls are divided into 4 categories:

Accidental:

Environmental hazards (e.g. trips/slips); falls from bed surfaces

Developmental:

Infants/toddlers as they are learning to walk, pivot and run

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Types of Falls cont’d

Anticipated Physiological:

Patient’s diagnosis or characteristics may predict their likelihood of falling (e.g. procedural sedation, post procedure recovery, unsteady gait)

Unanticipated physiological:

No obvious risk factors identified on assessment; falls related to conditions not anticipated such as first-time seizure, medication reactions

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Why do Patients Fall?

Combination of Factors such as:

Mobility Impairment (Gait Disturbance)

Generalized Weakness

Poor Balance

Use of Assistive Devices

History of Illness Related Falls

Before Admission

After Admission

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Why Do Patients Fall?

Medications

Medications including the following can increase the risk of falls:

Anticonvulsants

Opioids

Benzodiazepines

Sedatives/hypnotics

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Why Do Patients Fall?

Surgery/Procedural Sedation

Surgery or procedural Sedation within the last 48 hours

Cognition/Development

Developmentally and/or cognitively delayed/impaired patients

Very active, restless, or combative

Clinical Judgment

Clinical diagnosis or condition warrants fall prevention program

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Goals of the Falls Prevention Program

Decrease the incidence of falls

Decrease the severity of falls

Increase mobility and function

Improve environmental safety

Provide comprehensive assessment

Enhance staff knowledge

Improve Patients and Families confidence

RNAO http://www.rnao.org/Storage/26/2035_168Falls_Self-LearningPackage_FINAL.pdf

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Why Implement Falls Risk Reduction

Strategies?

Falls Risk Assessment & Intervention

Identification of risk prone children in a proactive manner to reduce the risk and number of falls

Falls Risk Assessment is Consistent with:

The RNAO Best Practice Guidelines

Organizational and Accreditation requirements and practices

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Who Assesses for Falls Risk?

Initial assessments and reassessments for each admitted patient will be the responsibility of the clinical nurse

Includes all B6 and PMDU treatment/One Day Stay patients

Reassessments can be made in conjunction with allied health team i.e. physiotherapists, occupational therapists

Clinical nurse to ensure documentation has taken place if assessment is done in conjunction with an allied health team member

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The Process

Paediatric Falls Risk

Assessment Score Established

Universal Fall Prevention, or

High Risk Fall Prevention

Assess Patient Using

Paediatric Falls Risk

Assessment

Complete

on Admission or

Transfer

Daily on Patient

Before Noon

Change in

Patient

Status

Paediatric Falls Risk Assessment Form

Paediatric Falls Risk Assessment Form

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Falls Risk Assessment

(front of form)

Place date and time at top of column each time an assessment is done

*admission, transfer, daily before noon and when patient condition changes

Assess patient for each risk using scoring guide on back of form

Record a number in the column for each risk

* If no risk is identified, place a 0 in the column

Total the score at the bottom of the column to establish the Paediatric Falls Risk Assessment Score

Initial below the total score

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Scoring Implications

Score Less Than Two →Implement Universal Fall Prevention Interventions

Score Equal To or Greater Than Two →Implement High Risk Fall Prevention Interventions

*both are recorded on back of form

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Prevention Strategies Assessment and

Implementation (back of form) Place date and time at the top of the column each time an assessment/implementation of prevention strategies is completed

*admission, transfer, daily before noon and when patient condition changes

Check off all interventions put in place

Note: all boxes for the applicable intervention category should have a mark in them (P , N/A, *, or →)

Use * & DAR documentation as needed

* indicates Clinical note, then can use → if unchanged on next assessment

Initial bottom of column

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Universal Fall Prevention Interventions

Paediatric Falls Risk Score Less Than 2

Active engagement of Patient and Care Giver (Family) in all Aspects of Falls Prevention

Bed Rails

IV pole Safety

5 point restraints in high chairs, strollers, tables

Orientation to Room

Recommended use of night lights in Patient rooms to decrease falls risk

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Universal Fall Prevention Interventions

Bed in Lowest Position unless patient directly attended, brakes on/side rails up where appropriate

One side rail up for every Patient recommended

Use of non-skid footwear for ambulation

Request that Care Giver (Family) bring in appropriate non-skid footwear i.e. non-skid slippers or running shoes

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Universal Fall Prevention Interventions

Assess elimination needs; supervise as needed

Call bell, personal items and walking aids within reach

Environment clear (avoid unnecessary clutter)

Ensure patient is appropriately secured in wheelchair/stroller/highchair/other seating equipment

Ensure brakes are engaged on moveable equipment before transferring patient

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Universal Fall Prevention Interventions

Assess for adequate lighting (use night lights where applicable)

Patient and Family education provided on Paediatric Fall Prevention Strategies and documented on Paediatric Fall Risk Assessment and Intervention Flowsheet

Paediatric fall Risk Assessment & Intervention Flowsheet on chart

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High Risk Fall Prevention Interventions Paediatric Falls Risk Assessment equal to or Greater than 2

Implement Universal Fall Prevention Interventions

Educate Patient/Care Giver (Family) regarding Falls Prevention Interventions

Document all education on Paediatric Fall Risk Assessment & Intervention Flowsheet

Apply crib topper where appropriate

Identify “Fall Risk” on Patient care board in Nurses Station

Accompany Patient with Ambulation

Observe Patient frequently Q1hour Patient Care Rounds as minimum

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High Risk Fall Prevention Interventions

cont’d

Keep patient room doors/bay curtains open at all times unless isolation procedures prohibit

Continuous supervision while toileting

Evaluate medications that increase Patient Fall Risk

Move Patients closer to the Nurses station where possible when a family member is not present

Consult Physiotherapy or Occupational Therapy where appropriate

Provide lift transfer if appropriate

Consider if constant supervision is required (Revera)

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High Risk Fall Prevention Interventions

cont’d

Assess all alternatives to using restraints (see restraint policy)

http://appserver.lhsc.on.ca/policy/search_res.php?polid=PCCO2O&live=1

Paediatric Falls Risk Assessment & Intervention Flowsheet on chart

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Patient and Family Education

Infant Population considered high risk for falls

Educate Parents re;

Isolettes

Scales

Crib Toppers

Crib Sides

IV tubing

Extra Items in Crib

Co-sleeping

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Patient and Family Education

Actively engage patient/family in Fall Prevention

Provide appropriate resources to Patient/Family on admission i.e. Patient and Family Handbook

Discuss Patients Fall Risk Status with Family/Caregiver

Teach re: Fall prevention strategies, e.g. Five point harnesses, non skid footwear

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Additional Documentation

Document Paediatric Falls Risk Assessment Score on Patients Graphic Record

Document Patients Fall Risk Status on Patient Care Kardex

Document all Patient or Care Giver Education/Reinforcement of teaching on the Paediatric Fall Risk Assessment and Intervention Flowsheet

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Together we CAN Make a Difference

For further information on preventing and reducing patient falls please visit the RNAO website

http://www.rnao.org/

http://www.rnao.org/Storage/12/617_BPG_Falls_rev05.pdf

http://www.rnao.org/Storage/26/2035_168_Falls_Self-LearningPackage_FINAL.pdf

Thank you Everyone!

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References

Hospital for Sick Children , Ambulatory Falls and Entanglement, Strangulation, Entrapment (ESE) Prevention, Toronto, 2011.

www.rnao.org Prevention of falls and fall injuries in the older adult, Toronto, 2011.