Paediatric Falls Education Case Study CLINICAL EXCELLENCE COMMISSION August 2014 Developed by NSW Paediatric Falls Resources Committee

Day 1 Ted is a 7 year old boy admitted with a diagnosis of gastroenteritis, and has been vomiting and had diarrhoea for 48 hours. He has severe (10%) dehydration, requiring IV hydration. Tests indicate acidosis. He is lethargic and weak. He is placed in a bed.

Example day 1 Age Score = 2 (7 to <13 yrs of age) Gender Score = 2 (male) Diagnosis Score = 3 (Alteration in Oxygenation) Cognitive Impairments Score = 2 (Forgets Limitations) Environmental Score = 2 (Normal Placement in Bed) Surgery/Sedation Score = 1 (None) Medications Score = 1 (None) Total Score

Day 3 Ted is a 7 year old boy admitted with a diagnosis of gastroenteritis. He is tolerating oral fluids, has had no further vomiting or diarrhoea, and is saline/heplocked. Ted is up “running” in the halls and going to the playroom.

Case Study Example day 3 Age Score = 2 Gender Score = 2 Diagnosis Score = 1 (Other Diagnosis) Cognitive Impairments Score = 1 (Aware of Limitations) Environmental Score = 2 OR/Sedation Score = 1 Medications Score = 1 Total Score

Day 1Day 3 Age Score22 Gender Score22 Diagnosis Score31 Cognitive Impairments Score21 Environmental Score22 OR/Sedation Score11 Medications Score11 TOTALS1310

7 ON ADMISSIONDate /TimeSignature Orientate child/parents/Carers to room Educate child/parents/Carers about the potential fall risk and interventions and provide information Educate child/parents/Carers on how to use the call bell - ensure nurse call bell & light is within easy reach Document that a plan of care has been discussed with the child/parents/Carer in clinical progress notes Bed/cot rails up. Assess for any gaps where a child could be injured or trapped; consider the use of additional safety precautions, such as bolster Place child in developmentally appropriate sized bed (may require low bed), brakes on Ensure child has non-skid footwear and appropriate clothing to prevent tripping Care actions relevant for all children as a component of ongoing clinical care ROUTINE CARE Assist toileting requirements as needed Bed heads and foot ends must be in place on all beds at as per hospital protocol If child mobilises with IV pole, ensure equipment is placed close to the centre of the pole, and IV lines are secure Ensure environment is clear of clutter and bed area is clear of trip hazards Curtains should be pulled back to enable full view of child, unless otherwise indicated Ensure adequate lighting and leave nightlight on where appropriate Keep room door open at all times unless specified isolation precautions are in use Care actions for all patients

Care actions for High Fall Risk patients (score of 12 or more) Additional considerations for high risk (score of 12 or above) patients: ROUTINE CARE At clinical handover communicate high fall risk status and interventions in place At a minimum check the child every hour if they are unattended Accompany the child when they are ambulating Consider moving child closer to nurses’ station Assess need for 1:1 general observation Review medication administration timings for children Engage child’s parents/carers in falls prevention interventions

Patient Safety Outcomes Patient Outcomes Decrease in falls incidents Decreased injury from falls Increased knowledge about falls prevention Program Outcomes Interdisciplinary approach to fall prevention and management Increased clinician awareness of fall prevention and management Use of standardised fall risk assessment tool and resources

Local Health District Falls Coordinator OR Local Health District Paediatric CNC OR Clinical Excellence Commission Who do I ask for more information?

Acknowledgements Miami Children’s Hospital (Humpty Dumpty Falls Assessment Program™) NSW Kids and Families Paediatric Falls Resources Committee Sydney Children’s Hospital Network NSLHD + CCLHD Paediatric Services John Hunter Children’s Hospital NSW Paediatric CNC Group

Thank you For further information: