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
• Add local LHD data here
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 Assessment Tool
Parameters
•
•
•
•
•
•
•
Falls Assessment Tool score
Age
Gender
At risk for falls if 12 or above
Diagnosis
Maximum Score 23
Cognitive impairments
Minimum Score 7
Environmental Factors
Response to Surgery / Sedation / Anesthesia
Medication usage
Look at the
whole
picture of
the patient.
2
1
3
2
2
3
2
15
When to do a Fall Risk Assessment
• Emergency Department
• Within 24 hours of admission
• When there is a major change in patient risk status
• Inpatient
• Upon admission
• When there is a major change in patient status
• Every 3 days or 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?
•
•
•
Add local process here e.g. NSW Paediatric Fall Risk
Assessment Tool can be accessed through PowerChart;
Adhoc charting
Assessment is to be completed within the first 6 hours
of admission to ward
Re-assessment every 3 days or when the child's
condition changes, including after a fall.
Children at a LOW risk of a fall
• Children at LOW RISK (score 7-11) must be:
– Reassessed at appropriate intervals during their
stay to check if risk level has changed
– Orientated to their room and any potential fall
risks
– Provided with the available Parent/carer
Information Sheets
– Localise to LHD/hospital process
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
Identified during bedside handover discussion
Have a fall risk management plan devised,
documented and communicated to staff, treating team
and family/carer (and patient where appropriate)
– Localise to LHD/hospital process
Parent/Carer Information
• Parent/carer information sheet should be
distributed to all parents/carers on admission
• A copy of the information sheet can be found
on the CEC website OR (LHD to insert local
location)
• Parents/Carers (and the child where
appropriate) must be informed of risk of falls
and involved in falls prevention management
planning.
Fall Prevention Management Planning
• Children identified at risk of a fall must have a
documented prevention management plan.
• 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?
• LHD to insert
local details
Post Fall Care Actions
1. Ensure patient is safe
2. Nursing assessment (including observations as per age
appropriate SPOC)
3. Medical review
4. Implement strategies to reduce risk of another fall
5. Document and communicate
6. Re screen and redo falls prevention management plan.
Note:
• Any Fall must be seen as a clinical priority
• All falls must be recorded in IIMS and in Patient
medical records
Who do I ask for more information?
• Local Health District Falls Coordinator
OR
• Local Health District Paediatric CNC
OR
• Clinical Excellence Commission
Discharge Planning
• 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
ED, admission to ward or Outpatients
using NSW Paediatric Fall Risk
Assessment Tool
Provide information
to parent/carer
Information sheet
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
IIMS plus inform senior clinicians involved
in child’s care
Discharge planning
Communicate risk and plan for
follow-up at home
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:
falls@cec.health.nsw.gov.au
www.cec.health.nsw.gov.au