In this section
Note: This guideline is currently under review.
Falls are the most common cause of paediatric injury leading to emergency department visits. It is widely acknowledged that children are at risk of falls in the community, with many education programs supporting prevention, it is important that this education is reflected in the hospital environment. Children fall as they grow, develop coordination and new skills; often unaware of their limitations, therefore one could conclude that all children are at some risk of falling.
The intention of this guideline is to raise awareness and educate nursing staff and the multidisciplinary team of the importance of maintaining a safe environment for all patients; assist with identifying patients who are high risk of fall; provide the tools to educate families and carers of the potential risk of falls and outline strategies to develop individualised management plans of care to reduce risk for high risk patients.
Fall- A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.
Anticipated falls -may occur when a patient whose score on a falls risk tool indicates she or he is at risk of falls.
Unanticipated falls - occur when the cause of the fall is not reflected in the patient's risk factor for falls, conditions exist which cause the fall, yet these are not predictable (e.g., the patient faints suddenly).
Accidental falls - occur when a patient falls unintentionally, usually as a result of tripping or slipping, as a result of equipment failure or other environmental factors. Patients can not be identified as being at risk for falls prior to this type of fall.
Risk assessment tool- a conceptual framework that organises knowledge on the aetiology of predicting falls.
All paediatric patients are considered at risk of falling and simple prevention strategies should be put in place to ensure the risk of injury is minimized. A safe environment should be maintained for all patients within the Royal Children's Hospital (RCH). Standard safety measures should be put place for all patients regardless of identified risk, these include:
Half of falls incidents within the RCH occur when a parent or carer is present. Whilst most parents are aware of maintaining a safe environment for their children in the home environment, many are unaware of the environmental risks when in hospital due to being in an unfamiliar environment accompanied with increased levels of anxiety related to hospital admission.
The hospitalisation of children provides an opportunity to reinforce parent/carer information and education concerning normal psychological and motor development of small children, which is related to falls risks and other hazards both inside and outside hospital
Parents/carers should be encouraged to:
All patients have a falls risk assessment completed using the Little Schmidy falls risk Assessment Tool completed at the following stages:
The falls risk assessment score is documented in the Patient Care Record (MR856/A) in most of the inpatient areas and in the Progress Notes (MR660/A), where the Patient Care Record is not utilised. In Medical Short Stay falls risk assessment scores are captured on the Short Stay Clinical Path (MR925-81/A) or in the Progress Notes (MR660/A) when patients are using alternative clinical paths. In the Paediatric Intensive Care Unit the risk assessment score is documented in the PICU Nursing Management Plan (MR855/A).
The falls risk assessment tool does not replace clinical judgment, if a patient does not present with a high risk score but is thought to be high risk by medical or nursing staff, allied health, parents or carers extra precautions to protect such patients should be documented and auctioned.
Factors influencing risk include
See Clinical Guideline (Nursing): Nursing Assessment for more detailed assessment information.
Standard safety measures should be put in place for all patients regardless of the risk identified
Falls score equal to or greater than 3 necessitates the implementation of a Falls High Risk Management Plan. Please note this form is currently being evaluated in Kelpie and Cockatoo Wards. Please use this form in all wards until the evaluation is complete and a formal MR is available.
For all patients identified as high risk, i.e., those with a falls risk score of 3 or greater; a Falls High Risk Management Plan must be commenced. The plan will be developed in collaboration with the child's parent or carer and will be specific to the patient's individual needs.
The plan will remain in use and visible in the bedside charts until the patients falls risk score changes. If the falls risk score alters a new plan will be implemented as the patients needs may have changed. Patient risk should continue to be assessed daily, once the patient's risk score is less than 3 and the patient's risk of falling is reduced, a management plan is no longer required; however it is important that a safe environment is always maintained.
A physiotherapist can advise as to how to safely support the patient during positioning, transfers, standing, walking and use of mobility aids.
An occupational therapist can ensure safe setup of the ward bedroom, bathroom and toilet to minimize falls risks and recommend management techniques/assistive equipment for self care tasks.
In the event of the occurrence of a fall:
Documentation of Falls event
Some patients may have a high risk score at the time of discharge. For this patient group the following should be considered:
Falls Prevention Evidence Table
Please remember to read the disclaimer.
The development of this clinical guideline was coordinated by Kylie Moon, Nursing Services. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. First published February 2012 (replacing Falls Prevention Procedure published July 2009), Reviewed February 2013.