Fall Prevention

CLINICAL GUIDELINES

Fall prevention measures are to be implemented by all healthcare providers, staff, and volunteers within the institution to ensure patient safety, prevent injury, and increase quality of healthcare outcomes.
A fall risk assessment will be completed on each child older than 8 months. This assessment will be completed by a registered nurse (RN). Children younger than 8 months are exempt from a fall risk assessment.
Reassessment of fall risk is completed when the child’s condition changes, with each shift assessment, when the child is transitioned to another level of care (e.g., postanesthesia unit to the medical/surgical unit), or medications are ordered that may increase the risk for falling.
Falls are defined an unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury” (ANA, 2005, p. 26). Developmental falls are those occurring secondary to a child’s developmental stage or age.
Falls may be caused by the following:
- An unsafe environment (e.g., crowded hallways and rooms, leaving bed rails down when child is resting)
- Response to a medication (diuretics, anesthesia, analgesics, sedatives, etc.)
- Developmental factors (toddlers learning to walk, running, and playing in the hallways or playrooms)
- Child’s health status (cerebral palsy, muscular disorders, neurologic disorders)
- Orthopedic diagnosis (fractures with/without casts, splints, external fixators)
- Medical devices (IVs, nasogastric tubes, chest tubes, etc.)
A fall prevention plan will include the following:
- Providing a clean and safe environment (see Chapter 97)
- Identifying children at risk for falls
- Nonpunitive reporting of the circumstances of patient falls
- Education and reeducation of staff on the fall guidelines
- Implementation of a fall intervention strategy, flexible enough to meet individual needs

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Review child’s health history, age, height, weight, review of systems, physical examination, baseline laboratory values, presence of orthopedic devices or the need for such devices, and current home medications (Chart 40-1).
Ensure child is oriented to unit environment. Falls can occur due to unfamiliarity with environment.

CHART 40-1 Fall Assessment Risk Factors

Neurologic impairment
Seizures
Use of assistive devices
Ambulation with IV pole and/or oxygen
Impaired mobility or sensory deficit
Impaired safety judgment
History of falls during previous hospitalization
Administration of any of the following:
- Diphenhydramine
- Hydroxyzine
- Narcotic analgesics (e.g., acetaminophen with codeine, morphine, oxycodone)
- Benzodiazepine agents (e.g., alprazolam, clonazepam, clorazepate, lorazepam)
- Vinca alkaloid agent (e.g., vinblastine, vincristine, vinorelbine)

TABLE 40-1 Pediatric Fall Assessment Tools

Tool	Evaluation Criteria
CHAMPS (Razmus et al, 2006)	Change mental status/Disorientation, History of Fall, Age less than 36 months, Mobility Impairment, Family Involvement, Safety
Cummings Pediatric Fall Assessment Scale (Cummings, 2005)	Fall History, Physical Function, Cognitive/Psychological Impairment, Equipment Need, Medication Altering Equilibrium
GRAF-PIF (Graf, 2004)	LOS, IV free, PT/OT need, Antiepileptic Medication, Ortho-muscular/skeletal Disorder, Fall history (past month or during this hospitalization)
Humpty Dumpty Falls Scale (Hill-Rodriquez et al., 2009)	Diagnosis & Age Driven; Cognitive Impairment, Environmental Factors, Responses to Surgery/Sedation/Anesthesia, Medication Usage
I’M SAFE (Neiman et al., 2011)	Impairment (PT/OT involved), Medication (seizure, narcotics, epidurals), Sedation, Admitting diagnosis (Neuro/Ortho), Fall History, Environment Care (restraints, IV, Foley, RN)