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Thursday, 15 July 2010: 8:30 AM
Learning Objective 1: To discuss the results of a multi-site study of inpatient falls in 26 CHCA Children's Hopsitals
Learning Objective 2: To explore the prevalence, charateristics and related injuries in pediatric patients who fall during hospitalization
Purpose: Although the Joint Commission (JC) and Institute of Medicine (IOM), identify inpatient falls as a significant patient safety risk, research regarding falls in pediatric settings is limited (Jamerson, 2009; Hill-Rodriguez, Messmer, 2008; Razmus, 2006; Graf, 2004; Cooper, 2007). A prospective multi-site study of inpatient pediatric falls was sanctioned by Child Health Corporation of America (CHCA) to determine prevalence, fall characteristics and related injuries, based on Donabedian’s structure-process-outcome model. Methods: A 70-item data collection tool (content validity established) was used in 26 CHCA pediatric hospitals to abstract data from occurrence reports, patient charts and staff interviews. Data analysis included calculated prevalence rates, descriptive statistics and regression analyses.
Results: Over a six-month period, 770 pediatric falls were reported; prevalence rate- 0.87/1000 patient days. Children who fell were early childhood age (39%), late childhood (32%); adolescence (24%) or infants (5%). Of those who fell, 70.4% were without injury; 27.5% mild injuries; none suffered serious injury or death. More falls occurred between noon-6pm with diagnosis of neurologic/developmental delay (21.2%) followed by respiratory (12.7%), gastroinstestinal (11.1%); 74.3% were supervised by an adult during the fall. Patients who fell were alert (86.6%), oriented (83.3%) and ambulating (27%). History of falling, gender, impaired balance, sedation, and environmental conditions were not discriminating factors. Over 50% of patients were identified at high risk using individual hospital’s fall risk assessment tools; less than 29% used GRAF-PIF (12.5%), Humpty-Dumpty (10.4%), or CHAMP (5.7%) tools.
Conclusion: Although fall prevalence rates are lower for pediatrics, as compared to adults, the results indicate that the pediatric fall risk tools need further refinement in an effort to address pediatric falls with adult supervision. These patients were alert, oriented, and ambulating, future research should delineate fall risk factors for pediatric patients, focusing on efforts to prevent serious injury through education and enhanced vigilance for all pediatric patients.
Results: Over a six-month period, 770 pediatric falls were reported; prevalence rate- 0.87/1000 patient days. Children who fell were early childhood age (39%), late childhood (32%); adolescence (24%) or infants (5%). Of those who fell, 70.4% were without injury; 27.5% mild injuries; none suffered serious injury or death. More falls occurred between noon-6pm with diagnosis of neurologic/developmental delay (21.2%) followed by respiratory (12.7%), gastroinstestinal (11.1%); 74.3% were supervised by an adult during the fall. Patients who fell were alert (86.6%), oriented (83.3%) and ambulating (27%). History of falling, gender, impaired balance, sedation, and environmental conditions were not discriminating factors. Over 50% of patients were identified at high risk using individual hospital’s fall risk assessment tools; less than 29% used GRAF-PIF (12.5%), Humpty-Dumpty (10.4%), or CHAMP (5.7%) tools.
Conclusion: Although fall prevalence rates are lower for pediatrics, as compared to adults, the results indicate that the pediatric fall risk tools need further refinement in an effort to address pediatric falls with adult supervision. These patients were alert, oriented, and ambulating, future research should delineate fall risk factors for pediatric patients, focusing on efforts to prevent serious injury through education and enhanced vigilance for all pediatric patients.