Stumbles and Tumbles: Part II Development of a Pediatric Fall Risk Assessment Scale

Purpose:
Identification of criteria to be included in a fall risk assessment scale specific to our pediatric population.

Background/Significance:
In response to concerns from staff regarding the accuracy of adult fall scales when used to assess pediatric patients, the Pediatric Practice Committee (PPC) conducted a literature review to identify risk factors that best predict falls in pediatrics. Utilizing those identified factors, the PPC developed a tool to audit the medical records of our pediatric inpatients who experienced falls. The data from the audits will be used to create a population specific pediatric fall risk assessment scale.

Methods:
This study is a retrospective patient record review. The PPC developed an audit tool containing all of the risk factors identified in the literature. In addition, the patient's age, length of stay, gender, and diagnosis were included. Confidentiality was maintained by recording the patient encounter number. The medical record and incident report of each pediatric patient who fell in the past eight years were audited for factors contributing to the fall. The information was recorded on the audit tool. All records were reviewed by two or more committee members to assure interrater reliability.

Results:
Risk factors for falls included: age ≤2 years; IV or IPID present; secondary diagnosis; seizure or sedative medications; history of falls; change in LOC; impaired mobility; developmental delay; weakness/vertigo; and a communication deficit. Falls were classified as environmental/equipment related, developmental, in response to treatment received, or physiological/psychological. Pt with an age of 2 years or less accounted for 53% of all falls. Males also accounted for 70% of falls that occurred. Eighty percent of fallers had a parent present at the time of the fall. Falls also occurred most frequently on the third day of stay in hospital with the range of stay being from 2-10 days.

Conclusions and Implications for Practice:
Hospitalized children are in an unfamiliar environment, placing them at greater risk for falls. Education is needed for both parents and staff. Plan: develop a pediatric specific fall risk assessment scale; educate staff; implement scale and parent education program; and evaluate effectiveness.