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Paediatric Falls Education
Case Study
CLINICAL EXCELLENCE COMMISSION
August 2014
Developed by
NSW Paediatric Falls
Resources Committee
Day 1
Ted is a 7 year old boy admitted with a
diagnosis of gastroenteritis, and has been
vomiting and had diarrhoea for 48 hours. He
has severe (10%) dehydration, requiring IV
hydration. Tests indicate acidosis. He is
lethargic and weak. He is placed in a bed.
Example day 1
• Age Score = 2 (7 to <13 yrs of age)
• Gender Score = 2 (male)
• Diagnosis Score = 3 (Alteration in
Oxygenation)
• Cognitive Impairments Score = 2
(Forgets Limitations)
• Environmental Score = 2 (Normal
Placement in Bed)
• Surgery/Sedation Score = 1 (None)
• Medications Score = 1 (None)
Total Score- 13
2
2
3
2
2
1
1
13
Day 3
Ted is a 7 year old boy admitted with a diagnosis
of gastroenteritis. He is tolerating oral fluids,
has had no further vomiting or diarrhoea, and is
saline/heplocked.
Ted is up “running” in the halls and going to the
playroom.
Case Study
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Example day 3
Age Score = 2
Gender Score = 2
Diagnosis Score = 1 (Other
Diagnosis)
Cognitive Impairments Score
= 1 (Aware of Limitations)
Environmental Score = 2
OR/Sedation Score = 1
Medications Score = 1
Total Score 10
2
2
1
1
2
1
1
10
Day 1
Day 3
Age Score
2
2
Gender Score
2
2
Diagnosis Score
3
1
Cognitive Impairments Score
2
1
Environmental Score
2
2
OR/Sedation Score
1
1
Medications Score
1
1
TOTALS 13
10
Care actions for all patients
ON ADMISSION
Date /Time
Signature
Orientate child/parents/Carers to room
Educate child/parents/Carers about the potential fall risk and interventions and provide information
Educate child/parents/Carers on how to use the call bell - ensure nurse call bell & light is within easy reach
Document that a plan of care has been discussed with the child/parents/Carer in clinical progress notes
Bed/cot rails up. Assess for any gaps where a child could be injured or trapped; consider the use of
additional safety precautions, such as bolster
Place child in developmentally appropriate sized bed (may require low bed), brakes on
Ensure child has non-skid footwear and appropriate clothing to prevent tripping
ROUTINE CARE
Care actions relevant for all children as a component of ongoing clinical care
Assist toileting requirements as needed
Bed heads and foot ends must be in place on all beds at as per hospital protocol
If child mobilises with IV pole, ensure equipment is placed close to the centre of the pole, and IV lines are secure
Ensure environment is clear of clutter and bed area is clear of trip hazards
Curtains should be pulled back to enable full view of child, unless otherwise indicated
Ensure adequate lighting and leave nightlight on where appropriate
Keep room door open at all times unless specified isolation precautions are in use
7
Care actions for High Fall Risk
patients (score of 12 or more)
ROUTINE
CARE
Additional considerations for high risk (score of 12 or above) patients:
At clinical handover communicate high fall risk status and interventions
in place
At a minimum check the child every hour if they are unattended
Accompany the child when they are ambulating
Consider moving child closer to nurses’ station
Assess need for 1:1 general observation
Review medication administration timings for children
Engage child’s parents/carers in falls prevention interventions
Patient Safety Outcomes
• Patient Outcomes
• Decrease in falls incidents
• Decreased injury from falls
• Increased knowledge about falls prevention
• Program Outcomes
• Interdisciplinary approach to fall prevention and management
• Increased clinician awareness of fall prevention and
management
• Use of standardised fall risk assessment tool and resources
Who do I ask for more information?
• Local Health District Falls Coordinator
OR
• Local Health District Paediatric CNC
OR
• Clinical Excellence Commission
Acknowledgements
Miami Children’s Hospital
(Humpty Dumpty Falls Assessment Program™)
NSW Kids and Families
Paediatric Falls Resources Committee
Sydney Children’s Hospital Network
NSLHD + CCLHD Paediatric Services
John Hunter Children’s Hospital
NSW Paediatric CNC Group
Thank you
For further information:
[email protected]
www.cec.health.nsw.gov.au