Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

FALLS PREVENTION CHW

POLICY

DOCUMENT SUMMARY/KEY POINTS

All patients must have a Falls Risk Assessment on admission to the ward and every three days thereafter, unless condition changes, through the Paediatric Risk Assessment Tool (PRAT) in PowerChart (except at Bear Cottage where a paper form is to be completed) There are identifiable falls risk factors for all children when admitted to hospital. CHW has adopted the Miami Childrens Hospitals Humpty Dumpty Fall Prevention Program to identify children at risk of falls. The Falls Risk Assessment Tool is a cumulative calculation of seven parameters. All children require the Falls Risk Protocol to be implemented in responds to their risk assessment score. If a child has a fall whilst in Hospital, an IIMS must be entered into Safety at Kids

All Children are at Risk of Falls. However, children with Scores 12 and above are at High Risk of Falling

This document reflects what is currently regarded as safe practice. However, as in any clinical situation, there may be factors which cannot be covered by a single set of guidelines. This document does not replace the need for the application of clinical judgement to each individual presentation. Approved by: Date Effective: Team Leader: SCHN Policy, Procedure & Guideline Committee 1st August 2012 Patient Safety Manager Original endorsed by CHW HCQC 2009 Review Period: 3 years Area/Dept: Clinical Governance Unit Page 1 of 6

Date of Publishing: 5 August 2012 8:08 PM K:\CHW P&P\ePolicy\Jul 12\Falls Prevention - CHW.doc

Date of Printing: 5 August 2012

This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.

Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

CHANGE SUMMARY

Due for mandatory review minor changes only. Include procedures for Bear Cottage.

READ ACKNOWLEDGEMENT

The following staff should read and acknowledge this policy: Nursing, Allied Health & Medical.

TABLE OF CONTENTS
Background ............................................................................................................................3 Definition ..............................................................................................................................3 Children at High Risk ........................................................................................................... 3 Assessing Risk .......................................................................................................................4 Parameters ..........................................................................................................................4 Completing the Falls Risk Assessment ............................................................................... 4 A risk assessment is required for all children upon admission and when condition changes; e.g. following surgery.. ......................................................................................... 4 Falls Procedure ......................................................................................................................5 When a Child Falls ................................................................................................................. 6 Bibliography ...........................................................................................................................6

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Date of Printing: 5 August 2012

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This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.

Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

Background
Falls risk has been identified as an area of concern by NSW Health given the significant number of incidents associated with these risks. For example NSW Healths Patient Safety and Clinical Quality Programs 2005-2006 Report on Incident Management, found there were 24,177 reported patient falls as principle incident type. In this report, reference is made to studies that estimate approximately 10% of incidents are documented. If this figure was applied to NSW Health, it would mean that over 241,000 falls across NSW Health occurred in one year. Over the last 9 years, SCHN has reported 920 falls incidents into IIMS. What we do know from analysis over time, many incidents have occurred whilst patients are in the care of the parent/ carer. Many of these occur as a result of cot-sides/ bedrails not being put up and recognising that hospital cot/ beds are a lot higher than the usual home furniture. However, curiosity and development of motor skills have also been related to these falls. On admission families should be made familiar with the differences between the home and hospital environment and furniture, on orientation to the ward. This is also supported by Falls Prevention posters around the wards and hospital lifts. CHW has adopted the Humpty Dumpty Fall Program from Miami Childrens Hospital into the electronic eMR Paediatric Risk Assessment Tool within PowerChart, as the tool to identify and reduce falls risk. This research shows that falls outside of the hospital environment are the leading cause of unintentional injury for children. Of these falls, half of the injuries occurred in children younger than five years old, with children under 10 having the greatest risk of fall-related death and injury.

Definition
Falls: An unintended event resulting in a person coming to rest on the ground/floor or other lower level (witnessed) or reported to have landed on the floor (un-witnessed) not due to any intentional movement or extrinsic force such as a stroke, fainting, seizure. (FHA) Adjusted Fall: An unintended event resulting in a person coming to rest on the ground/floor or other lower level (witnessed) or reported to have landed on the floor (un-witnessed)

Children at High Risk

Preschoolers Children under ten are twice at risk for falls compared with the total population Children with disabilities and minimal mobility may be at greater risk Children in wheelchairs, regardless of cognitive ability are at risk from wheelchair tips and falls Children with a neurological diagnosis Children with Challenging and /or impulsive behaviours
Date of Printing: 5 August 2012 Page 3 of 6

Date of Publishing: 5 August 2012 8:08 PM K:\CHW P&P\ePolicy\Jul 12\Falls Prevention - CHW.doc

This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.

Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

Assessing Risk
The Childrens Hospital at Westmead is adopting the Miami Childrens Hospitals Humpty Dumpty Falls Assessment Tool which is based on a retrospective review of pediatric falls.

Parameters
The falls parameters include:

Age Gender Diagnosis Cognitive impairments Environmental Factors Response to Surgery / Sedation / Anaesthesia Medication usage

Completing the Falls Risk Assessment

At CHW the Falls Risk Assessment tool is completed in Powerchart by the admitting nurse. This is accessed via the ad hoc charting function. At Bear Cottage, a paper based version of this risk assessment tool is to be completed on admission. The tool is a cumulative calculation. There are seven parameters and each receives a minium score of 1. If any parameters are not applicable, the child will always receive a score of 1. If the child falls into multiple categories, the highest score will be given.

Each parameter is added in a cumulative fashion:

The highest score a child can receive is 23 The lowest score the child can receive is 7 Any child with a score of 12 or above is considered at high risk.

A risk assessment is required for all children upon admission and when condition changes; e.g. following surgery..

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Date of Printing: 5 August 2012

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This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.

Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

Falls Procedure
All children will receive a falls risk score on admission. Once the falls risk score has been identified, the management and interventions must be initiated and documented in the clinical notes.

Patients scoring 7 -11 (Low Risk) require the following interventions:

o o o

Orientation to room Bed in low position, brakes on Bed/cot rails x2 or x4 up. Assess for any gaps where a child could get extremities or other body parts entrapped; consider the use of additional safety precautions, such as bolsters. Bed heads and foot ends must be in place on all beds at CHW. Use of non-skid footwear for ambulating patients, use of appropriate size clothing to prevent tripping Assess elimination needs: assist as needed If child mobilises with IV pole, ensure medical equipment is placed close to the centre of the pole, and lines are secure. Ensure nurse call bell and light is within easy reach. Educate child/ family on its functionality. Ensure environment is clear of unused equipment, furniture is stacked or put away, bed area is clear of trip hazards Curtains should be pulled back to enable full view of child, unless inappropriate Assess for adequate lighting, leave nightlight on. Ensure child and family receive education regarding falls risk. Document falls prevention teaching in clinical progress notes and include in plan of care where applicable.

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Patients scoring 12 - 23 (High Risk) require the following interventions:

o o o o o o o o o o

Children at High risk are identified during clinical handover Implement all strategies for children identified as low risk (as above) Educate child/ parents about the falls protocol interventions. Check the child minimum every hour if they are unattended Accompany the child when they are ambulating Place child in developmentally appropriate sized bed (may require low bed) Consider moving child closer to nurses station Assess need for 1:1 general supervision (refer to CHW policy Specialling) Evaluate medication administration times Keep door open at all times unless specified isolation precautions are in use

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Date of Printing: 5 August 2012

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This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.

Policy No: 1/C/09:8024-01:03 Policy: Falls Prevention CHW

When a Child Falls

Staff need to:

Assess child and provide immediate care. Notify childs medical team to review child and document plan of care. Notify Nursing Unit Manager or Team Leader. Document fall in childs clinical record, incorporating the following:
o o o o o o

Childs appearance at time of discovery Childs response to event Activity at time of fall (if known) Evidence of injury Location Medical and nursing actions taken

Complete IIMS report. Inform parents/guardian if not present at time of fall. Falls Risk Assessment should be re-assessed and documented.

Bibliography
1. 2. The Miami Childrens Hospital Humpty Dumpty Falls Scale and Prevention Program. (2006), www.mch.com Buick. M & Purser. L (2007). Fall Prevention is a Team Effort: Strategies to reduce pediatric falls. UCSF Childrens Hospital. http://www.childrenshospitals.net/Content/ContentGroups/EducationMeetings2/SpringConference/2007/Po sters/Quality/NACHRIFallPreventionPoster030107.ppt#1 Patient Safety and Clinical Quality Programs 2005-2006. http://www.health.nsw.gov.au/pubs/2006/pdf/patient_safety_3.pdf National Safe Kids Campaign http://www.safekids.org/tier3 VA National Centre for Patient Safety. http://www.va.gov/NCPS/CogAids/FallPrevention/index.html Incident Management Policy: http://chw.schn.health.nsw.gov.au/o/documents/policies/policies/20068324.pdf

3. 4. 5. 6.

Copyright notice and disclaimer: The use of this document outside Sydney Children's Hospitals Network (SCHN), or its reproduction in whole or in part, is subject to acknowledgement that it is the property of SCHN. SCHN has done everything practicable to make this document accurate, up-to-date and in accordance with accepted legislation and standards at the date of publication. SCHN is not responsible for consequences arising from the use of this document outside SCHN. A current version of this document is only available electronically from the Hospitals. If this document is printed, it is only valid to the date of printing.
Date of Publishing: 5 August 2012 8:08 PM K:\CHW P&P\ePolicy\Jul 12\Falls Prevention - CHW.doc Date of Printing: 5 August 2012 Page 6 of 6

This Policy/Procedure may be varied, withdrawn or replaced at any time. Compliance with this Policy/Procedure is mandatory.