A Multi-site Pediatric Fall Study

Purpose:
A retrospective Children's Health Corporation America (CHCA) multi-site study of inpatient pediatric falls was conducted to determine prevalence, characteristics and related injuries, based on Donabedian's structure-process-outcome model.

Background/Significance:
Although 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 (Messmer, 2010, Jamison, 2009; Graf, 2008; Hill-Rodriguez, Messmer, 2008; Razmus, 2006).

Methods:
Researchers/CNSs from 26 CHCA children's hospitals used a 70 item data collection tool (content validly established) to abstract data from occurrence reports and patient charts. Data analysis included calculated prevalence rates and descriptive statistics analyses.

Results:
Over 6 months 782 pediatric falls occurred; prevalence rate (95%CL)- 0.88/1000 pt days. Infants (20%), toddler/preschool (25%), school-aged (32%) & adolescence (23%); 66.2% no injuries. Patients alert (86.6%), oriented (83.3%), ambulating (27%) with 74.7% adult supervision; more falls occurred between 12-6pm with #1 diagnosis-neurologic/developmental delay. Gender, hx falling, impaired balance, sedation, and environmental conditions not significant factors. Using fall risk tools (87.3%) resulted in statistically significant lower fall rates (0.774, 0.781 vs. 0.931,0.936 p<0.001); GRAF-PIF 11.8%; HDFS 8.8%, or CHAMP 5.3%; however, 50.3% patients were not identified as high risk.

Conclusions and Implications for Practice:
Pediatric patients at risk of falling with parental presence due to family centered care must be monitored frequently with vigilance, preventing serious injury. Further research should examine intervening variables and determine sensitivity/specificity of pediatrics fall risk tools.