An Evidence-based Approach to Fall Risk Assessment
Roni L. Cummings, RN, MSN, Quality Resource Management, Phoenix Children's Hospital, Phoenix, AZ, USA
Background: The Joint Commission of Accreditation of Healthcare Organizations has identified a national patient safety goal to monitor the risk for falling and to reduce the risk of injury from falls (JCAHO, 2004). Assessment tools developed for the adult population are not appropriate for use in pediatrics. This study was undertaken to determine risk factors for pediatric falls in an inpatient setting and to develop a fall risk assessment tool. Methods: Systematic review of the literature was performed to evaluate pediatric fall risk. No pediatric studies were found, nor was a pediatric fall risk assessment tool identified. Occurrence reports of falls in a pediatric acute care setting were reviewed. Seventy-eight inpatient medical records with a fall were reviewed and compared with 78 age and diagnosis-matched controls that did not fall to determine fall risk factors. Results: Twenty-eight factors were identified as potentially related to a fall. Higher incidence of falls was noted with toddlers who had parents present and among patients with a co-morbid diagnosis of ADHD. Environmental factors were also identified. A tool, incorporating these findings, was constructed using six categories similar to the Morse scale (Williams, 2002) After expert validity testing, the tool was piloted for daily assessment of fall risk. Results from the pilot testing indicated that environmental and developmental factors were more likely to be associated with a fall. Of those evaluated, less than 5% of patients fell. Falls occurred more often in the evening hours. No serious injury occurred from falls during the pilot phase. Conclusions: Pediatric fall risk assessment data will be used to develop a fall prevention program and forenhancing family and staff education for preventing harm from falls in the pediatric inpatient setting.