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Journal club Pediatric Falls. Cheryl Stohler RN BSN University of Central Florida. The Humpty Dumpty Falls Scale: A case-control study. Hill-Rodriguez, D., Messmer , P., Williams, P., Zeller, R., Williams, A., Wood, M. & Henry M. (2009) JSPN 14 (1) . Why are Falls important?

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Journal club

Pediatric Falls

Cheryl Stohler RN BSN

University of Central Florida

The Humpty Dumpty Falls Scale: A case-control study

Hill-Rodriguez, D., Messmer, P., Williams, P., Zeller, R., Williams, A., Wood, M. & Henry M. (2009) JSPN 14 (1)

Why are Falls important?
  • Second most costly type of injury
  • Largest single category of hospital inpatient reports
  • It has been estimated that an average ward will have about 10 falls per month of which 30% cause some harm and 1–5% lead to serious injury
  • Joint Commission’s National Patient Safety Goals include the provision for patients and their families to report concerns about safety, including falls.
What defines a Fall?
  • Falls are defined as any sudden, unintentional change in position that caused an individual to land at a lower level, on an object, on the floor, or on the ground.
  • A near miss is when a patient my lose his balance or become weak and someone lowers him to the floor and an
  • Injury is defined as a disruption of an unplanned event requiring intervention.
Inpatient falls can be classified into three categories
  • Accidental falls: such as environmental considerations (33%) Even with parents present 57% of the time
  • Anticipated physical/physiologic factors such as such as medications, post-op (61%)
  • Unanticipated physiologic falls unexpected events, such as syncope, seizure fractures (6%)
How are falls measured?

Incident reports in the acute care setting use the following ANA–NDNQI fall-related injuries categories:

(1) None indicates that the patient did not sustain an injury secondary to the fall.

(2) Minor indicates those injuries requiring a simple intervention.

(3) Moderate indicates injuries requiring sutures or splints.

(4) Major injuries are those that require surgery, casting, further examination (e.g., for a neurological injury).

(5) Deaths refers to those that result from injuries sustained from the fall

Evidence Based Research findings :Humpty dumpty Study
  • Children at-high risk for falls (2.5%- 3.0% per 1,000 patient days)
  • Preschoolers (agers 19-24 months)
  • Children under 10 are twice at risk for falls compared with the total population
  • Children with disabilities and minimal mobility
  • Children in wheelchairs regardless of cognitive ability
  • Males are 2:1 ratio for falls
  • Diagnosis Respiratory/pulmonary/ENT #1/ Neurological #2
  • Those NOT within 24 hours post op
  • Those who are NOT NPO
  • More fell on a Monday, followed by Thursday
  • Highest falls in October
  • Falls related to equipment include tripping over equipment or furniture, falls out of cribs or falls due to spills
Implication for nursing –for all patients:
  • Bed in low position, rails up, brakes on
  • Keep environment clear of excess equipment, furniture, personal items
  • Keep call light within reach
  • Educate family of safety factors and to be extra diligent
  • Assess elimination needs and offer assistance every 2 hours accompany all children regardless of age/gender into bathroom.
  • Assess oral intake needs and offer every 2 hours
  • Use non-skid footwear for all patients
  • Assess for adequate lighting
  • Encourage parents to accompany child at all times when ambulating
  • Document in EMR so it shows in banner bar
  • Document in education section parent/guardian education re: falls
  • Post fall risk contract and explain team effort
Additional consideration for high risk for falls
  • Keep patient doors open at all times unless on isolation for all high risk patients
  • Apply “Fall Risk” bracelet on patient next to arm bracelet
  • Document in EMR so it shows in banner bar
  • Document in education section parent/guardian education re: falls
  • Post fall risk contract and explain team effort
  • Post door sign outside patient room
  • Assess need for 1:1 supervision.
  • Consider moving patient closer to nurses station
  • Hands-off bedside report

WCH policy/procedure: Fall Prevention#6056

  • Additional category: Developmental fall: falls that are common to the child as they grow and develop. These falls are considered normal and are not reported unless they result in injury
  • Children under age 3 are to sleep in crib
  • Once a patient is assessed and identified as high risk for falling, they will remain on high risk fall precautions fro the length of the hospital stay.
  • Incident reports are used to record patient falls
  • Falls are tracked per unit and hospital wide
What else can we do to decrease falls?

Properly identifying patients at risk for falls ensures all disciplines, parents and visitors have awareness to prevent a fall.

Increased awareness results in less falls and injury due to these falls

Education to everyone helps improve patient/healthcare communication


Hill-Rodriguez, D., Messmer, P., Williams, P., Zeller, R., Williams, A., Wood, M. & Henry M. (2009) JSPN 14 (1)

Wolfson Children’s Hospital Policy and Procedure Manual : 2013