Paper
Thursday, 20 July 2006
This presentation is part of : Developing Surveys and Scales
Implementing a Humpty Dumpty Falls Scale for Pediatric Patients
Maria Wood, ARNP, MSN1, Deborah HIll-Rodriguez, ARNP, MSN, CS-BC1, Patricia R. Messmer, PhD, RN, BC, FAAN2, Maryann Henry, MBA, BSN, BS, CP3, Deborah Salani, MSN, ARNP4, Dania Vazquez, ARNP, MSN3, Maria E. Soto, ARNP, MSN, MBA5, and Cheryl Minick, BSN, RN, BC6. (1) Nursing Department, Miami Children's Hospital, Miami, FL, USA, (2) Nurse Researcher, Miami Children's Hospital, Miami, FL, USA, (3) Miami Children's Hopsital, Miami, FL, USA, (4) Peditric Intensive Care Unit, Miami Children's Hospital, Miami, FL, USA, (5) Miami Children's Hospital, Miami, FL, USA, (6) Maimi Children's Hospital, Miami, FL, USA
Learning Objective #1: Identify a Pediatric Falls tool for planning, implementing and reviewing falls data.
Learning Objective #2: Understand patterns of injury for educating nurses & parents regarding falls prevention.
JCAHO mandates Children’s hospitals to describe fall and injury rate trends and implement high risk fall protocols. Hendrich (2003) and Morse (2002) developed risk assessment tools to identify patients at risk for falls, focusing on elderly (Diener & Mitchell, 2005).  Children under the 10 have greatest risk of fall-related death and injury (National Safe Kids Campaign, 2004; Park, 2004). Levene & Bonfield (1991) reported falls from improper use of cribs. Most falls occurred in children < 5; half occurred with parents present. Graf (2005) developed GRAF-PIF predictor model, reporting predictors of 12-24 months, male 1-2 ratio with neurological & respiratory diagnosis. Purpose of this research protocol was to validate Humpty Dumpty Falls© Scale assessing pediatric patients at high risk for falls. Research questions: What parameters should be included in pediatric falls assessment tools and what score indicates at risk for falls? Methodology: Humpty Dumpty Falls© scale was created from historical falls reporting and PI data identifying average scores. Falls safety protocol for low risk/high risk evolved from parameters with risk factors criteria and scoring matrix using 23 maximum and 7 minimum score.  A score of 12 and above indicated patients at-risk for falls.  Results: Review of 50 patients falling during 2005 compared to 50 (control group) (matching age and diagnosis) who did not fall. Results-most falls occurred in children under 3 but 2nd 12 years+ with neurological dx. Compared to 2-1 ratio for males (2000) results indicate trend toward more falls in females. Conclusions: Humpty Dumpty Falls© scale was validated (at-risk score of 12+) with dx of seizure #1 predictor, dehydration/vomiting 2nd asthma 3rd.  These results differ from Graf (2005); older children were identified at high-risk with neurological dx. Nursing Implications: Implementing patient falls safety protocols should identify patients at-risk-for falls thus reducing incidences while addressing JCAHO Patient Safety Goals.

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