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 in the community and 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.and are 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.
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.
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 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 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 patient's 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 minimise falls risks and recommend management techniques/assistive equipment for self-care tasks.In the event of the occurrence of a fall:
Documentation of a fall 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
Click here to view the evidence table.
Please remember to read the disclaimer.
The development of this nursing guideline was coordinated by Nadine Stacey, Clinical Lead, Quality and Safety, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2017.