Development of an Evidence-based Pediatric Fall Prevention Program

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UNINTENTIONAL falls are the leading cause of pediatric nonfatal injury, as well as emergency department visits, and remain a major public health concern.1,2 Falls injure more children aged 14 years and younger than any other unintentional injury. More than 2.5 million children in this age group are treated annually at hospital emergency departments for fall-related injuries, and boys are twice as likely as girls to die from fall-related injuries.3 The US Public Health Service estimates that two thirds of all falls (pediatric and adult) could be prevented.4Although some people believe that it is normal for children to fall, falls are not “accidents” but are consequences of specific, intrinsic risk factors.4 Falls can occur in all settings, especially in hospitals during an acute care situation where patients are at high risk.5 Medication use, a new environment, and underlying medical conditions can hinder orientation and understanding of children, which may increase their risk of falling. Staff will encounter patients who attempt to get out of bed without help. Pediatric patients have the additional risk of falling due to their stage of growth and development. The challenge for hospitals is to manage patient risk and reduce fall incidence. Successful fall reduction programs must begin with staff commitment. A shift in culture from fall reaction to fall prevention is needed.6Members of the Nursing Research Committee (NRC) at Children's Hospital Central California assumed the tasks of developing and implementing a pediatric fall prevention program using research and evidence-based nursing practice. The team examined available information on pediatric falls and developed a fall prevention program for the organization.IDENTIFYING THE PROBLEMOne of the current National Patient Safety Goals outlined by the Joint Commission on Accreditation of Healthcare Organizations is to reduce the risk of patient harm resulting from falls. The NRC was asked to use evidence-based practice in developing a pediatric fall prevention program to support this goal. This project required the NRC to develop, implement, and evaluate a pediatric fall prevention program. The NRC adopted a common “fall” definition. A patient fall is a “sudden unexpected descent from a standing, sitting or horizontal position, including slipping from a chair to the floor and an assisted fall (where an individual guides the falling individual to the floor), with or without injury to the patient.”7 Initial program development required the NRC to identify the epidemiology of pediatric hospital falls to include information about characteristics of patients who fall, circumstances surrounding falls, and fall-related injuries that result.REVIEW OF THE LITERATUREThere is extensive literature on adult patient falls and adult hospital fall prevention programs. Adult hospitals report inpatient fall rates from 2.3 to 7 falls per 1000 patient days.7 Patient falls constitute a major proportion of hospital occurrences and can result in injury, extended stays, and decreased independence. Programs enhancing patient care and safety are nursing priorities. Use of a fall risk-assessment tool to assess patients at risk for falls, application of a standardized nursing care plan, and an ongoing educational program on fall prevention for staff were identified to significantly reduce the fall rate within an inpatient population.8 Many of these fall risk factors are associated with an underlying pathophysiological cause or are a direct result of a disease process. Studies have examined intrinsic factors such as physiological changes and medication usage and extrinsic factors such as environmental characteristics (eg, lighting and floor surfaces) that may contribute to patient falls.8–12 Morse et al13 identified 6 significant variables in patients who fall: history of falling, secondary diagnosis, intravenous therapy, use of ambulatory aids, gait, and mental status.

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