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NSW Paediatric Fall Risk Assessment CLINICAL EXCELLENCE COMMISSION November 2014 Developed by NSW Paediatric Falls Resources Committee
NSW Paediatric Fall Risk Assessment
CLINICAL EXCELLENCE COMMISSION
November 2014
Developed by
NSW Paediatric Falls
Resources Committee
Paediatric Fall Resource for NSW
• The CEC in collaboration with NSW Kids and Families have purchased a state-wide license to use the Miami Children’s Hospital Humpty Dumpty Falls Assessment Tools™
• The Humpty Dumpty Falls Assessment Tools have been localised to NSW and will now be known in NSW as the NSW Paediatric Fall Risk Assessment Tool
Fall Risk Screening
• Falls are a leading cause of injury for children
• Falls are one of the major preventable risks factors for in increased length of stay for paediatric patients in NSW hospitals
• National Safety and Quality Health Service Standards -Standard 10: Preventing Falls and Harm from Falls
• Patient safety initiative
Falls Definition
• Miami Children’s Hospital defines a fall as:
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 (unwitnessed)
-This can be from standing, bed, cot or chair (World Health Organisation)
Incidence - Paediatric Falls in the hospital
• The incidence of falls at Allowah is low due to our mostly non-ambulant population.
• There have been 2 falls related to incorrect use of hoist slings in the last year.
Environmental Causes - Paediatric Falls in the hospital• Result of improper use of cot (crib) side rails either
partially raised or incorrectly secured (Levene and Bonfield, 1991)
• Children less than one year old tended to fall out of bed while adolescents tended to fall while ambulating to or in the bathroom. Other factors included slipping on a wet surface or tripping over an object. Parents were in attendance most of the time (Cooper and Nolt, 2007)
• Majority of falls in children younger than 10 are related to crib, rails, playrooms and well-intended parents who may forget and leave the child unattended with the side rail down (Hendrich 2007)
Who is at risk of a fall?• Preschoolers
• Children under 10 years
• Children with disabilities and minimal mobility
• Children with neurological diagnosis
• Children with challenging and/or impulsive behaviours
• Children in wheelchairs, regardless of cognitive ability
Paediatric fall risk factors• History of previous falls related to illness• Cognitive impairment from sedation, anaesthesia,
disorientation, developmental delay• Impaired mobility/inadequate muscle tone• Central nervous system disorders• Sensory impairment e.g. poor vision• Needs to go to the toilet frequently or has diarrhoea• Post operative restrictions such as pain, casts/splints,
mobility aids etc• Takes medications associated with increased risk of falls
e.g. psychoactive, anticonvulsants
Consequences of Falls
• Minor to serious injury
• Increased stay in hospital
• Impact on family/carer
• Potential change in independence on discharge
• Increase in patient/family/carer costs
• (Death – rarely)
NSW Fall Risk Screening Tool Parameters
• Age
• Gender
• Diagnosis
• Cognitive impairments
• Environmental Factors
• Response to Surgery / Sedation / Anesthesia
• Medication usage
Little Schmidy Falls Screen on Admission
The child is at high risk if the score is 3 or above
Refer to allied health for an assessment
When to do a Fall Risk Screen • Admission
• Immediately upon admission
• When there is a major change in patient status
• After a fall
• Outpatient Settings
• Upon initial visit to the outpatient setting
• With each age change
• When there is a major change in patient status since last visit
Where do I document my Fall Risk Assessment results?
• Document the risk screen on the admission form
• Assessment is to be completed within the first 6 hours of admission to ward
• Re-assessment when the child's condition changes, including after a fall.
Children at a LOW risk of a fall
• Children at LOW RISK (score <3) must be:
– Reassessed at appropriate intervals to check if risk level has changed. This usually occurs at their yearly Patient Care review
– Referred to allied health for assessment if there is a concern that their risk is greater than scored.
– Reassessed by allied health if a fall or near-fall occurs.
Children at a HIGH risk of a fall
• Children at HIGH RISK (score 12 or above) must be: – Identified at general “Handover” – Identified on the Handover sheet– Have a fall risk management plan devised, documented
and communicated to staff, treating team and family/carer (and patient where appropriate)
– Will have a FRAT (Falls risk assessment tool) completed by the physiotherapist in consultation with other staff and parents.
– A prevention management plan for preventing a fall will be documented and placed on the child’s clipboard.
PRESENTATION NAME – MONTH YYYY
PRESENTER NAME
Identification of High Fall Risk
• For children assessed to have a high risk of falling a sticker is placed under their identification photo on the clipboard and above their bed to alert staff to this risk.
• When staff see this sticker it is important to look at the recommendations in the FRAT assessment tool to prevent a fall.
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Parent/Carer Information
• Parent/carer information should be available to all parents/carers.
• Parents/Carers (and the child where appropriate) must be informed of risk of falls and involved in falls prevention management planning.
• All falls will be communicated to the parent/ carer.
Fall Prevention Management Planning• Children identified at risk of a fall must have a
documented prevention management plan. (developed by the physiotherapist and relevant health staff and family).
• This includes relevant referrals and further assessments.
• This must be developed in conjunction with parent/carer (and child where appropriate).
• Must be re-evaluated when the child's condition changes, including after a fall.
What is a Fall Prevention Management Plan?
Post Fall Care Actions
Note: • Any Fall must be seen as a clinical priority• All falls must be recorded in Patient medical
records and entered into TICKIT
1. Ensure patient is safe2. Nursing assessment (including observations)3. Medical review4. Implement strategies to reduce risk of another fall5. Document and communicate 6. Re-screen and redo falls prevention management plan.
• Registered Nurse in Charge of the shift
OR
• Physiotherapist
OR
• Work Health and Safety Coordinator.
Who do I ask for more information?
Discharge Planning
• If necessary, communicate fall risk status and ongoing recommendations/referrals to patient, family/ carers and relevant service providers
– General Practitioners
– Community Health Services
– Community Service Providers
Summary of Falls Prevention Initiatives
Identify and assess
all patients
Admission to ward or Outpatients using
NSW Paediatric Fall Risk Assessment
Tool (Little Schmidy at Allowah)
Provide information
to parent/carer
Information sheet (Copy of the
assessment)
Risk assessment
and management
Implement and document falls risk
management plan for high risk children
Change in condition
(or fall)
Reassess and reconsider management
plan. Follow local post fall care actions
Reporting and
monitoring
TICKIT plus inform senior clinicians
involved in child’s care
Discharge planning Communicate risk and plan for
follow-up at home
AcknowledgementsMiami 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
