In this section
Definition of Terms
Maintaining a safe environment for all patients
Educating families and carers
Considerations for discahrge
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, 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. RCH incident data suggest those at the highest risk of falls are those in the toddler age group (1-2 years) and the adolescent group (10-17 years).
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 at high risk of falls; provide the tools to educate families and carers of the potential risk of falls and outline strategies to develop 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
Near miss fall – when a fall was likely but did
not occur, but was averted due to action by patient, carers or staff.
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 cannot 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 in 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 Primary Assessment flow sheet in the EMR.
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 actioned
Factors influencing risk
Factors influencing risk include:
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 which is located in the Primary Assessment flowsheet within the EMR.
Falls score equal to or greater
than 3 necessitates the implementation of a Falls High Risk Management Plan which is located in the Primary Assessment
flowsheet within the EMR.
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 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 referral may be needed to a
physiotherapist or an occupational therapist if there has been a change to a
patients mobility or function during an admission.
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 minimise falls
risks and recommend management techniques/assistive equipment for self care
In the event of the occurrence of
Documentation of a Falls event
Some patients may have a high
risk score at the time of discharge. For this patient group the following
should be considered:
High risk patients may be eligible for Post Acute Care (PAC). To make a
referral contact the RCH Complex Care Hub.
Little Schmidy Falls Risk Assessment Tool
Fall and Entrapment Prevention and Management Guideline Appendix
B: Paediatric Cot and Bed Allocation Guide (attached below)
Click here to view the
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Sarah Sly, Improvement Manager, and approved by the Nursing Clinical Effectiveness Committee. Updated April 2022.