Running head: PEDIATRIC FALLS EDUCATION
Educating Nurses on Pediatric Falls Risk Assessment Scales and Falls Prevention Measures
Amanda Sikora and Lindsay Snyder
The Pennsylvania State University - Capital Campus
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PEDIATRIC FALLS EDUCATION
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Abstract
Pediatric falls were identified as a current problem on the pediatric acute care unit at
Hershey Medical Center. A review of the literature was conducted and information regarding
pediatric falls risk assessment and falls prevention interventions was identified. This information
was presented to nurses via an educational poster and their knowledge regarding falls
information before and after viewing the poster was assessed and recorded. As hypothesized,
nurse knowledge of falls risk assessments and interventions improved after viewing the poster.
There is a need for further research in pediatric falls to determine the most effective pediatric
falls risk assessment scale and prevention interventions.
Keywords: falls risk assessment, falls prevention interventions, nurse falls education
PEDIATRIC FALLS EDUCATION
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Educating Nurses on Pediatric Falls Risk Assessment Scales and Falls Prevention Measures
Patient safety in the hospital environment is a top priority for healthcare organizations.
Patient falls that occur in the hospital have remained both an important and challenging patient
safety issue for many of these organizations. In 2005, the Joint Commission created a patient
safety goal that focused on reducing the harm caused by inpatient falls. Then, in 2006, the Joint
Commission required hospitals to implement falls reduction programs with the goal of reducing
the harm resulting from inpatient falls (The Joint Commission, 2007). Additionally, the Magnet
accreditation program identifies falls as a nursing sensitive indicator and those organizations
seeking Magnet accreditation must meet or exceed national falls benchmarks in order to receive
accreditation (Graf, 2011). When magnet status depends on criteria that is without a benchmark,
against which it can be measured, as is so in pediatric fall risk assessment, hospitals need to be
innovative, establish a bar to set for the industry, and create that standard that allows for growth
and guidance (Graf, 2011). Falls in general can contribute to longer hospital stays,
comorbidities, irreversible injuries, and a significant amount of money that is not always covered
by insurance and thus may force the hospital to foot the bill (Graf, 2011; Schaffer et al., 2012).
The goals set forth by the aforementioned organizations as well as the overall desire of
organizations to improve safety and reduce patient falls, makes preventing falls an important
topic for healthcare organizations today.
Much research has been done on inpatient falls and their effects in the adult population
(Child Health Corporation of America Nursing Falls Study Task Force, 2009). There are
established falls risk scales and falls prevention programs that have been validated and are
widely utilized in the adult population (Graf, 2011). The research and recommendations for
inpatient falls in the pediatric population, however, are much more limited. Although falls occur
PEDIATRIC FALLS EDUCATION
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at a lower rate in the pediatric population, the rate of injury sustained from falls in the pediatric
population is nearly the same as in the adult population (Jamerson et al., 2014). Injuries from
falls can lead to an increased length of stay, increased complications and decreased family trust
in the healthcare team (Graf, 2011). The impact that these falls have on patient outcomes makes
inpatient falls an important topic to examine further in the pediatric population.
The purpose of this research project is to assess nurse knowledge of falls risk assessment
scales and falls prevention measures on the pediatric acute care floor at Hershey Medical Center.
The review of the literature will explore the efficacy of pediatric falls risk assessment scales, the
importance of caregiver education in relation to falls prevention, and effective inpatient falls
prevention measures. The research project will address the following PICO question: In
registered nurses working on the pediatric acute care unit, can a pediatric falls education poster
improve nurses’ knowledge of pediatric falls scales and interventions to prevent falls? It is
hypothesized that nurses’ knowledge of the aforementioned pediatric falls information will
improve after viewing an educational poster.
Review of the Literature
Fall Risk Assessment Scales
According to Hill-Rodriguez et al. (2009), the first step in preventing falls is identifying
those who are at a high risk for falling. There is a great deal of research regarding falls in the
adult population and there are validated tools that meet the appropriate sensitivity and specificity
criteria which can identify those who are at risk for falls in the adult population (Hill-Rodriguez
et al., 2009). The literature is much more limited in the pediatric population and there is much
debate regarding the best tool to utilize in this unique population (Graf, 2011). Studies suggest
that it is important to test screening tools within specific patient populations in order to
PEDIATRIC FALLS EDUCATION
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determine which scale is most appropriate (Graf, 2011; Jamerson et al., 2014). Regardless of the
tool chosen to evaluate risk status, performing the evaluation at frequent intervals is important so
that high risk patients can be monitored more frequently, falls prevention strategies can be
implemented and parents can be educated regarding falls prevention strategies (Graf, 2011).
In a study, Ryan-Wenger, Kimchi-Woods, Erbaugh, LaFollette, and Lathrop (2012),
discuss the validation of the Pediatric Fall Risk Assessment (PFRA) tool which was developed to
evaluate patients at low or high risk for falling. Demographically, there was no difference
between control patients, who did not fall, compared to the variable patients who did fall,
according to gender or ethnicity/gender. They found sensitivity scores ranging from 47.2% to
85.3% among GRAF-PIF, Humpty Dumpty, and CHAMPS scales, which are three of the most
widely used pediatric fall assessment scales in the country. These three scales were compared to
the ten item risk factors that make up the PFRA. The sensitivity scores of the three compared
assessment tools fall short of the agreed upon standard of 90% or greater sensitivity. While the
PFRA scored a 95.1% sensitivity rating, the 60% false-positive and 58.5% false-negative ratings
the scale received were deemed unacceptable, giving none of the scales tested accurate enough
precision or accuracy to determine fall risk among hospitalized pediatric patients (Ryan-Wegner,
Kimchi-Woods, Erbaugh, LaFollette, & Lathrop, 2012).
Harvey, Kramlich, Chapman, Parker, and Blades, (2010) researched five pediatric fall
assessment instruments in order to compare the assessment tools and their criteria. Again, the
study determined more research is required on this topic. The study concluded that two of the
five instruments performed well, however, each scale assessed had negative attributes which
negated the accuracy of fall risk prediction among pediatric patients. The CNMC and CHAMPS
assessment tools revealed no errors yet the CNMC showed to have the least statistical accuracy
PEDIATRIC FALLS EDUCATION
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and the incapability to predict which children were of the highest risk (Harvey et al., 2010). This
study found an additional risks, the length of stay and experiencing previous falls during the
hospital stay, to contribute to the risk of falls among pediatric patients. Harvey et al. (2010) also
determined the risk to be nine times greater of falling in children with temperament/behavior
issues. The found blood disorders and cautions about potential bleeding to increase the risk of
falls by four as compared to those hospitalized children without hematological identifiers
(Harvey et al., 2010).
The Humpty Dumpty Fall Scale (HDFS) is a widely used fall assessment scale
throughout the country, which was developed at Miami Children’s Hospital. The scale was
developed as a response to the need for fall risk assessment among the pediatric population
where little to no pediatric specific risk factors had been identified. A Hill-Rodriguez et al.
(2009) article based on a 2005-2006 chart review of 308 total patients determined that the HDFS
may serve as a valid tool for recognizing pediatric patients who are at high risk for falls. Again,
the study reported additional research is needed, but overall found the use of the HDFS on
admission, at least once per shift, and upon change of patient level of care to at least bring more
awareness to the potential risk of falls among the pediatric population (Hill-Rodriguez et al.,
2009). In a direct contradiction of the Hill-Rodriguez et al. (2009) study, a case-control study of
pediatric falls reviewing electronic medical records was done in 2013, finding the HDFS to have
a sensitivity of 57% and a specificity of 39% (Messmer, P. Williams, & A. Williams, 2013).
Messmer, P. Williams, and A. Williams (2013) admit the HDFS captures some of the risks
identified with patients in a pediatric setting however, the low sensitivity and specificity of the
scale indicate further assessment of the tool and probable adjustments needing to be made. The
contradicting views on the HDFS contribute to the confusion and inconsistent nature of the risk
PEDIATRIC FALLS EDUCATION
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factors and assessment criteria the pediatric community so desperately wants to avoid (Messmer,
P. Williams, & A. Williams, 2013).
Caregiver Presence
Studies have found that falls in the pediatric population often occur in the presence of
caregivers. In a study conducted at 26 Child Health Corporation of America-member hospitals,
77% of children had an adult present in the room at the time of the fall (Jamerson et al., 2014).
Another study found that caregivers were present during the fall 82.8% of the time (Razmus,
Wilson, Smith, & Newman, 2006). These findings showcase a unique problem surrounding
patient falls in the pediatric population. Since caregivers are present for the majority of falls, it is
pertinent to explore what can be done to prevent pediatric inpatient falls in the presence of
caregivers.
Prevention Measures
To date, there are no published pediatric hospital falls prevention programs (Cooper &
Nolt, 2007). Several studies, however, have found interventions that have led to a reduction in
pediatric falls. One study examined existing fall prevention methods on the pediatric units at the
National University Hospital of Singapore. The researchers in this study utilized knowledge of
current fall prevention measures and falls data from their electronic health record to determine
priority interventions that could be implemented to prevent falls. They determined that
reinforcement of fall prevention education for parents and caregivers should be done via physical
checks that occur at the change of shift and a falls prevention poster should be placed at the foot
of the patient bed (Lee, Yip, Goh, Chiam, & Ng, 2013). They did a pre and post-implementation
audit and found that the implementation of the falls prevention strategies reduced overall fall
rates from 1.0 falls per 1000 patient days in April-June 2010 to 0.3 falls per 1000 patient days in
PEDIATRIC FALLS EDUCATION
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April-June 2011 (Lee et al., 2013). There was a 100% reduction of falls in children three and
younger in the presence of caregivers from April-June 2010 to that in 2011 (Lee et al., 2013).
This study highlights the importance of reinforcing falls education and providing additional
methods of teaching, like posters, to serve as a reminder of fall prevention strategies for both
nurses and caregivers.
Another study examined facilities and their varying methods of carrying out falls
prevention education. Facilities had a lower fall rate if they used a pamphlet to educate patients
and caregiver regarding use of side rails and educated patients and caregivers on more than one
occasion regarding fall prevention (Fujita, Fujita & Fujiwara, 2013). The study identified that
caregivers can find it difficult to use hospital equipment and thus may have difficulty correctly
utilizing side rails, which can increase the child’s risk of falling (Fujita et al., 2013). They also
found that it is not adequate to utilize verbal explanation alone to educate parents as facilities that
utilized pamphlets and educated parents one more than one occasion during the hospital stay had
a significantly lower fall rates (Fujita et al., 2013).
Furthermore, a study completed by the Child Health Corporation of America suggests
that a falls risk assessment should be completed and patients should be reassessed when
assessment findings change and high risk patients should be identified via a physical marker such
as a sticker or identification band, should wear non-slip footwear and should receive frequent
monitoring (Child Health Corporation of America Nursing Falls Study Task Force, 2009). The
researchers suggested that nurses should also offer assistance to those at a high risk for falls,
should evaluate medication administration times in order to best reduce the risk of the patient
falling, and should educate caregivers on the appropriate use of side rails and proper ambulation
techniques (Child Health Corporation of America Nursing Falls Study Task Force, 2009).
PEDIATRIC FALLS EDUCATION
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By assessing patients for their falls risk status at frequent intervals, staff can readily
identify patients that are at risk for falls and educate caregivers accordingly. All of the
aforementioned studies highlight the importance of utilizing a validated falls risk assessment
scale and involving caregivers in falls prevention efforts and education. Utilizing different
measures for falls risk identification, such as wrist bands, communicating risk during shift report
and providing consistent reinforcement of falls education via posters and verbal explanation,
both nurses and caregivers can be part of the solution to reduce the number of falls that occur in
the pediatric population. It is of the utmost importance that nurses have a thorough
understanding of falls risk assessment scales and falls prevention interventions in order to create
a safe environment for patients and ultimately reduce the number of inpatient pediatric falls.
Action Plan
The idea for this research project was identified by exploring priority topics on the
pediatric acute care unit at Hershey Medical Center. One priority topic of interest was that of
falls that occur in the inpatient setting in the pediatric population. The pediatric acute care unit
experienced seven total falls from the months of January 2015 through October 2015 and, as a
result, the unit was actively working to improve nurse knowledge of falls risk assessment and
falls prevention interventions. As mentioned in the review of literature, falls prevention is not
only an individual hospital goal but falls have been identified by both the Joint Commission and
Magnet accreditation program as nursing sensitive indicators (The Joint Commission, 2007;
Graf, 2011). All of the aforementioned factors identified falls as a priority topic to address in
this research project.
PEDIATRIC FALLS EDUCATION
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Methods
It was decided that this project would address the following PICO question: In registered
nurses working on the pediatric acute care unit, can a pediatric falls education poster improve
nurses’ knowledge of pediatric falls scales and interventions to prevent falls? To begin this
project, a falls education poster was created by gathering pertinent falls information from the
literature and falls data from the pediatric acute care unit at Hershey Medical Center (Appendix
A). The poster focused on general falls information, falls risk assessment scales, falls risk
factors, and falls risk identification measures utilized at Hershey Medical Center. From the
information included in the educational poster, a falls knowledge assessment questionnaire was
created (Appendix B).
In the next step of the project, over several weeks on the floor, 18 nurses on the pediatric
acute care floor at Hershey Medical Center were given the falls knowledge assessment
questionnaire. Nurses included were part-time and full-time floor nurses of the pediatric acute
care floor, float nurses that regularly floated to the pediatric acute care floor, and charge nurses
or clinical heads from the pediatric acute care floor. The nurses filled out the questionnaire
based on their current falls knowledge, the questionnaire was collected and the data was
recorded. The same 18 nurses then viewed the falls education poster. After viewing the poster,
they were administered the same falls knowledge assessment questionnaire and the data was
recorded.
Results
After the data was collected, the results were compiled and analyzed. The results are
shown in Figure 1 (Appendix C) and a graphical analysis is shown in Graph 1 (Appendix D).
According to the pre-test results, the nurses on the pediatric acute care floor at Hershey Medical
PEDIATRIC FALLS EDUCATION
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Center were aware of the need for educating parents or caregivers in the room with a child with
100% of them acknowledging the need for caregiver education and what to include and what not
to include in the caregiver education. The nurses had a much more difficult identifying all of the
items that were actually included in the Humpty Dumpty Fall Scale as 0% of nurses were able to
choose all criteria correctly. Another area of weakness included only 33% of the nurses knowing
that pediatric falls happen less frequently than adult falls. Although many were unaware of the
frequency of pediatric falls, 83% knew that injury occurred just as often in pediatric falls as they
do in adult falls. While the results varied among individuals, 83% of the nurses were able to
correctly answer how many falls the floor currently had this year, which fall alerts were in place
on the floor, and what the best definition of a fall was. After the review of the falls education
poster (Appendix A), many of the nurses were able correctly answer more of the questions in the
post-test. The nurses on the pediatric acute care floor still had a difficult correctly identifying the
criteria included in the HDFS with only 33% answering correctly.
Discussion
Overall, viewing the educational falls poster improved nurse knowledge regarding unit
falls information and prevention measures. The nurses on the pediatric acute care floor, upon
assessment of their questionnaire results, seemed to recognize the importance of caregiver
education is and what information should be included in caregiver teaching. They had the most
difficult time in recognizing the components of the Humpty Dumpty Fall Scale. Although this
might seem trivial, it is important for nurses to understand the factors that place children at an
increased risk for falls. By understanding the components of the Humpty Dumpty scale, nurses
can readily recognize the things that place a child at a high risk of falling and can intervene
appropriately.
PEDIATRIC FALLS EDUCATION
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Interestingly, aside from the questionnaire, many of the nurses commented on how
helpful an educational falls prevention poster in the room would be due to the lack of retention
caregivers have when education about falls is conducted. Their recommendation of supplying a
falls prevention poster at the bedside has been studied and documented in the literature and has
been found to improve caregiver knowledge of falls prevention and ultimately reduce fall rates
(Lee, Yip, Goh, Chiam, & Ng, 2013).
Limitations
As mentioned in the review of the literature, there is limited data and research regarding
pediatric falls (Graf, 2011). In addition, there are no established pediatric falls risk prevention
programs (Cooper & Nolt, 2007). In an ideal setting, this research project would have gone
beyond just assessment of nurses’ knowledge of pediatric falls risk assessment scales and
interventions and would have addressed this gap in the knowledge. An additional limitation,
which proved to be quite baffling, was the lack of data on how much hospital costs are impacted
by pediatric inpatient falls. With the way hospitals are run today where it seems as though the
bottom line is more important than care at times, one would expect extensive data of the
financial impact pediatric falls have on an organization. Furthermore, unreported falls, how a
fall is defined between organizations, and the way studies are done are all potential limitations
related to this topic.
In 2007, the NRC defined a fall as a “sudden unexpected descent from a standing, sitting,
or horizontal position, including slipping from a chair to the floor and an assisted fall (where an
individual guides the falling individual to the floor), with or without injury to the patient”
(Cooper & Nolt, 2007). In 2012 study of a 10-item Pediatric Fall Risk Assessment (PFRA), it
was explained how one third of the cases they analyzed had to be dismissed due to the way the
PEDIATRIC FALLS EDUCATION
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falls were categorized. Falls characterized as “accidental” and preventable but not predictable
were the falls eliminated from the study. Only those falls that were called intrinsic physical or
physiological in origin were considered in that study (Ryan-Wenger et al., 2012). The same
article discussed the occurrence of falls that are not reported. While many may want to deny
behavior like this occurs in a hospital nurses through the PFRA study admitted that not all falls
are reported or even noted in the medical record (Ryan-Wenger et al., 2012).
Implications
Ideally, if this research project were to be explored further on the pediatric acute care unit
at Hershey Medical Center, a required, standardized falls assessment and education protocol
would have been implemented unit-wide. To ensure a seamless implementation, a unit chair
from night shift and day shift would be selected to assist in leading the implementation process.
These two individuals would share in the responsibility of holding staff meetings and
disseminating communication in conjunction with management and the education department.
Information regarding the new falls assessment and education protocol would be disseminated in
this communication and staff members would have the opportunity to discuss any questions or
concerns prior to the implementation of the new protocol.
Requirements for implementation would include assessment of all patients’ risk for falls
upon admission utilizing the Humpty Dumpty Fall Scale. Risk for falls would be reassessed
every four hours and documented in the patient’s electronic medical record. All patients,
depending on age, and their families would receive standardized education, based on information
from the most current literature, regarding falls in the inpatient setting and what they can do to
help with falls prevention. All patients at high risk for falls would be required to have
documentation of their high risk status in their electronic medical record, would wear a “falls
PEDIATRIC FALLS EDUCATION
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risk” bracelet, would have a falls education poster placed in their room and would have “falls
risk” indicated on the sign outside of their doorway.
To assess the efficacy of the new falls protocol, weekly chart and patient room audits
would be performed. Charts would be checked to ensure that patient’ risk status is evaluated and
documented utilizing the Humpty Dumpty Fall Scale according to protocol. Room audits would
be done to ensure that patients at a high risk for falls have all of the appropriate risk
identification measures as defined in the protocol. Additional evaluation would include monthly
analysis of falls data gathered from the MIDAS system. Furthermore, staff surveys would be
completed on a monthly basis to assess staff perception of the efficacy of the new falls
prevention protocol and would allow for staff to suggest improvements.
By rolling out an evidenced-based falls risk assessment and falls prevention protocol,
falls rates prior to and post implementation could be analyzed. Once efficacy of the new
protocol is confirmed, the protocol could be rolled out on other pediatric units at Hershey
Medical Center including the neonatal intensive care unit, continuing care nursery, pediatric
intensive care unit, pediatric intermediate care unit and the pediatric hematology/oncology unit.
There is clearly a lack of pre and post implementation analyses to show the most effective
interventions in reducing pediatric falls rates. Such research could help to bridge the knowledge
gap and could eventually lead toward a standardized falls prevention protocol that could be
utilized on a national level.
Conclusion
In conclusion, the importance of addressing pediatric falls is evident. Both the Joint
Commission and Magnet accreditation program have recognized the importance of addressing
falls and have identified them as nursing sensitive indicators (The Joint Commission 2007; Graf,
PEDIATRIC FALLS EDUCATION
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2011). The requirements of these national organizations as well as the desire to prevent falls and
reduce harm to patients showcases the importance of developing protocols to prevent falls in the
pediatric population.
This research project set out to explore nurses’ knowledge of falls and whether or not a
falls education poster could improve nurse knowledge of falls risk assessment scales and falls
prevention measures. The results of the research indicated that a falls education poster was
effective in improving nurse knowledge of the aforementioned falls information. Nurses were
particularly apt at identifying the importance of caregiver falls education and were aware of the
falls prevention interventions in place on the unit. They struggled, however, with identifying the
components of the Humpty Dumpty Fall Scale. It is pertinent that nurses have a better
understanding of the factors that place a patient at a higher risk for falls so that they are able to
intervene appropriately.
Overall, the implementation of this project was fairly seamless. The issue of falls was a
priority issue on the pediatric acute care unit that was readily identified by nurse leaders and
preceptors. The review of the literature provided much background information regarding
pediatric falls as well as falls risk assessment scales and falls prevention interventions. It was
simple to then create and educational poster from the knowledge gained in the review of
literature and subsequently create a falls knowledge assessment questionnaire based on the
information included in the educational poster. Nurses on the unit were eager to participate in
the project which aided in effortless data collection. The results of the implementation were
consistent with the hypothesized outcome that nurses’ knowledge of falls would improve after
viewing the educational falls poster.
PEDIATRIC FALLS EDUCATION
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This improvement in nurse knowledge with a simple falls education poster is just the
beginning to implementing changes that can lead to better patient falls outcomes. The data and
research is severely lacking related to the most effective falls risk assessment and falls
prevention measures. To further expand on this research project, in an ideal setting, assessing
additional nurses to include all that work on the pediatric acute care unit and the knowledge
deficit they face would be instrumental. A more extensive literature review could be conducted
to assess evidence-based practice that addresses the limitations mentioned above and an
evidence-based falls prevention protocol could be implemented on the pediatric acute care unit at
Hershey Medical Center. The falls data could be compared before and after the implementation
of the new protocol to determine if the measures included in the protocol were effective in
reducing the number of falls. If these measures were found to be effective, the protocol could be
implemented on other pediatric units and eventually might contribute to creating a standardized,
national falls prevention protocol. Creation of such a protocol could ensure that the most up to
date, evidence-based measures are being implemented in order to prevent inpatient pediatric falls
which can ultimately can lead to better patient outcomes.
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References
Child Health Corporation of America Nursing Falls Study Task Force. (2009), Pediatric falls:
State of the science. Pediatric Nursing, 35(4), 227.
Cooper, C. L., & Nolt, J. D. (2007). Development of an evidence-based pediatric fall prevention
program. Journal of Nursing Care Quality, 22(2), 107-112. Doi:10.1097/01.NCQ.0000263098.83439.8c
Fujita, Y., Fujita, M., & Fujiwara, C. (2013). Pediatric falls: Effect of prevention measures and
characteristics of pediatric wards. Japan Journal of Nursing Science, 10(2), 223-231.
doi:10.1111/jjns.12004
Graf, E. (2011). Magnet Children’s Hospitals: Leading knowledge development and quality
standards for inpatient pediatric fall prevention programs. Journal of Pediatric Nursing,
26(2), 122-127, doi:10.0106/j.pedn.2010.12.007
Harvey, K., Kramlich, D., Chapman, J., Parker, J., & Blades, E. (2010). Exploring and
evaluating five pediatric falls assessment instruments and injury risk indicators: An
ambispective study in a tertiary care setting. Journal of Nursing Management, 18(5), 531.
doi: 10.1111/j.1365-2834.2010.01095.x
Hill-Rodriguez, D., Messmer, P. R., Williams, P. D., Zeller, R. A., Williams, A. R., Wood, M.,
& Henry, M. (2009). The humpty dumpty falls scale: A case-control study. Journal for
Specialists in Pediatric Nursing : JSPN, 14(1), 22-32. doi:10.1111/j.17446155.2008.00166.x
Jamerson, P., Graf, E., Messmer, P., Fields, H., Barton, S., Berger, A.,…Lunbeck, M.
(2014). Inpatient Falls in Freestanding Children’s Hospitals. Pediatric Nursing, 40(3),
127-135.
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Lee, Y. L. G., Yip, W. K., Goh, B. W., Chiam, E. P. J. & Ng, H. P. C. (2013), Fall prevention
among children in the presence of caregivers in a paediatric ward: a best practice
implementation. International Journal of Evidence-Based Healthcare, 11: 33–38. doi:
10.1111/1744-1609.12003
Messmer, P., Williams, P., & Williams, A. (2013). A case-control study of pediatric falls
using electronic medical records. Rehabilitation Nursing, 38(2), 73-79.
doi:10.1002/rnj.73
Razmus, I., Wilson, D., Smith, R. & Newman, E. (2006). Falls in hospitalized children.
Pediatric Nursing, 32(6), 568-572.
Ryan-Wenger, N., Kimchi-Woods, J., Erbaugh, M., LaFollette, L., & Lathrop, J. (2012).
Challenges and conundrums in the validation of pediatric fall risk assessment tools.
Pediatric Nursing, 38(3), 159-167.
Schaffer, P. L., Daraiseh, N. M., Daum, L., Mendez, E., Lin, L., & Huth, M. M. (2012). Pediatric
inpatient falls and injuries: A descriptive analysis of risk factors. Journal for Specialists
in Pediatric Nursing, 17(1), 10-18. doi: 10.1111/j.1744-6155.2011.00315.x
The Joint Commission (2007). Improving America's Hospitals: A Report on Quality and Safety.
Retrieved from http://www.jointcommission.org/assets/1/6/2006_Annual_Report.pdf
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Appendix A
PEDIATRIC FALLS EDUCATION
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Appendix B
Pediatric Falls Knowledge Questionnaire
Please answer the following questions about pediatric falls using your current knowledge on the subject
and what protocol states on 3 Acute Care at HMC Children’s Hospital.
1. True or False: Pediatric falls are less common than adult falls.
a. True
b. False
2. True or False: Falls in pediatric patients are less likely to result in injury.
a. True
b. False
3. True or False: Falls education should be provided to parents/caregivers and documented upon
patient admission.
a. True
b. False
4. Which of the following items are included in the Humpty Dumpty Falls Risk Assessment
scale? Select all that apply.
a. Age
b. Gender
c. Diagnosis
d. Impairments
e. Environmental
f. Response to Surgery
g. Medication Usage
h. Caregiver Presence
i. History of Falls
5. Which of the following items are currently in use to alert staff that a patient is at risk for falls?
Select all that apply.
a. Falls risk ID bracelet
b. Flag outside of the patient’s room
c. Patient wearing different colored gown or socks
d. Falls risk poster at the bedside
e. Documentation of risk status in the patient’s chart
6. Which of the following should be not be included in caregiver falls education?
a. Keep side rails up
b. Remain at the bedside at all times
c. The wheels of the bed/crib should be locked
d. The patient should wear non-slip footwear
e. The bed should be in a low position
7. A pediatric nurse knows the best definition of a fall is
a. A gradual decline of an individual from any position or height that results in injury to the
patient.
PEDIATRIC FALLS EDUCATION
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b. A sudden, unexpected descent from a standing, sitting, or horizontal position, including
slipping from a chair to the floor and an assisted fall (where an individual guides the falling
individual to the floor), with or without injury to the patient
c. A sudden drop from standing, sitting, or horizontal position, including slipping from a chair
to the floor and an assisted fall (where an individual guides the falling individual to the floor),
resulting in injury to the patient.
d. A gradual or sudden decline from an unspecified position, location, or height not including a
patient slipping from a chair to the floor and an assisted fall (where an individual guides the
falling individual to the floor), with or without injury to the patient.
8. The Children’s Acute Care floor has had how many fall incidents since January 2015?
a. 7
b. 3
c. 4
d. 2
PEDIATRIC FALLS EDUCATION
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Appendix C
Table 1: Falls Knowledge Assessment Results
Question
Correct
Answer
% Correctly
Answered PreAssessment
% Correctly Answered
Post-Assessment
True or False: Pediatric falls are less common than
adult falls.
True
33%
100%
True or False: Falls in pediatric patients are less
likely to result in injury.
False
83%
100%
True or False: Falls education should be provided to
parents/caregivers and documented upon patient
admission.
True
100%
100%
Which of the following items are included in the
Humpty Dumpty Falls Risk Assessment scale?
Select all that apply.
A. Age
B. Gender
C. Diagnosis
D. Impairments
E. Environmental
F. Response to Surgery
G. Medication Usage
H. Caregiver Presence
I. History of Falls
A, B, C, D,
E, F, G
0%
33%
Which of the following items are currently in use to
alert staff that a patient is at risk for falls?
A. Falls risk ID bracelet
B. Flag outside of the patient’s room
C. Patient wearing different colored gown or
socks
D. Falls risk poster at the bedside
E. Documentation of risk status in the patient’s
chart
A, B, E
83%
83%
Which of the following should be not be included in
caregiver falls education?
A. Keep side rails up
B
100%
100%
PEDIATRIC FALLS EDUCATION
B.
C.
D.
E.
23
Remain at the bedside at all times
The wheels of the bed/crib should be locked
The patient should wear non-slip footwear
The bed should be in a low position
A pediatric nurse knows the best definition of a fall
B
is
A. A gradual decline of an individual from any
position or height that results in injury to the
patient.
A. A sudden, unexpected descent from a
standing, sitting, or horizontal position,
including slipping from a chair to the floor
and an assisted fall (where an individual
guides the falling individual to the floor),
with or without injury to the patient
B. A sudden drop from standing, sitting, or
horizontal position, including slipping from
a chair to the floor and an assisted fall
(where an individual guides the falling
individual to the floor), resulting in injury to
the patient.
C. A gradual or sudden decline from an
unspecified position, location, or height not
including a patient slipping from a chair to
the floor and an assisted fall (where an
individual guides the falling individual to
the floor), with or without injury to the
patient.
83%
83%
The Children’s Acute Care floor has had how many
fall incidents since January 2015?
A. 7
B. 3
C. 4
D. 2
83%
100%
A.
PEDIATRIC FALLS EDUCATION
24
Appendix D
Graph 1: Falls Knowledge Assessment Results Pre-test and Post-test Comparison