In preventing falls, children are no less deserving of protection than the elderly
In preventing falls, children are no less deserving of protection than the elderly
Pediatric falls require different strategies, not same old thing
Falls among elderly patients are high on the priority list for any risk manager, but what about your patients on the other end of the spectrum? Are you doing all you can to prevent falls among your youngest patients?
The prevalence rate of falls among pediatric patients is lower than for elderly ones, but the risk of serious injury still is high enough to warrant concern from risk managers, says Elaine Graf, RN, PhD, research and funding coordinator for clinical and organizational development at Children’s Memorial Medical Center in Chicago. Graf and her colleagues at Children’s recently completed a major research project concerning falls among children.
She cautions that addressing falls in a pediatric population is not as simple as applying the same strategies you use in an elderly group. Some of the causes and predictors of falls are different, and the strategies must be tailored to children.
For instance, hip protectors sometimes are used to help prevent hip fractures in elderly patients, but a child who falls is more likely to hit his or her head. Soft helmets can sometimes be appropriate, Graf adds.
It is easy for risk managers to overlook risk of falls among younger patients or to assume that the usual strategies work for them also, says Ruth Ragusa, RN, vice president of organizational effectiveness at South Nassau Communities Hospital in Oceanside, NY.
Ragusa has been working with Eileen Mahler, RNC, MSN, assistant director of nursing for women & children services, who has been working on the investigation of patient falls in the hospital and the analysis of their causes, as well as leading the drafting and implementation of protocol to prevent them.
The strategies with children must be different because children are not like older patients, Ragusa says. Elderly patients tend to fall when trying to do common, everyday things such as going to the bathroom. Children can fall in that situation too, she notes, but they also try to climb on top of the desk, build a fort in their beds, and see how fast they can turn a corner while racing wheelchairs.
"The similarity, however, is the way families perceive your organization after a fall," Ragusa points out. "They put their loved one in your charge and expected you to protect them; and when that patient is injured in a fall, they see the child and the elderly patient the same, as someone who needed your protection. They don’t look on it any less harshly when the patient is young and fell while he was doing what kids do."
She notes that risk managers may need to focus their pediatric falls prevention effort everywhere except the pediatric ward. Good prevention strategies are needed there, of course, but most pediatric nurses already focus on the risk and know the special needs of their young patients, Ragusa explains. The real risk for falls may come when the patient moves from that ward to a unit in which other staff may not be as familiar with how to prevent falls in children.
For instance, if the patient is taken to radiology and left in the care of the staff there, the risk of falling may skyrocket, she says.
"The awareness of the staff is not the same once you leave the pediatric unit," Ragusa notes. "The pediatric staff understand the risk very well but others in the hospital may not look at that child and understand the risk of falling and how that risk is different from other patients."
That’s where risk managers can do a lot of good, she says. A hospitalwide education effort can help alert nonpediatrics staff to the fall risk when working with children.
One of the difficulties in preventing pediatric falls is that they can be seen as just normal occurrences for a child, says Mary Ward, RN, MSN, nursing director of the medical infectious disease unit at Children’s. Whereas adult patients are not expected to fall down without reason — and elderly patients are known to fall accidentally — falls among children sometimes are seen as just a normal part of growing up.
That is true sometimes, of course, but health care organizations still must work to prevent the accidental and health care falls that can result in injury, she adds. That starts with educating staff that a child who falls still counts as a patient fall, unless it clearly is a normal occurrence like a 1-year-old stumbling as he or she learns to walk.
"That’s a mindset that we need when working with children," Ward continues. "When someone sees an older patient fall, we automatically know that’s a problem. When you see a 5- or 10-year-old patient fall, it’s easy to dismiss it as no big deal, but that’s not necessarily the case."
Mahler cautions that one size does not fit all when it comes to preventing falls in kids. The risks and necessary strategies will depend very much on the child’s age and development, she says.
"What works for the older patient doesn’t necessarily work with children; and what works with the 5-year-old might not work with the 12-year-old patient," Mahler adds. "You have to tailor what you’re doing to the specific situation."
Graf and Ward agree with that advice, and they say the research at Children’s has yielded a unique model for predicting which pediatric patients are at risk of falling. Using a fall-prediction model based on retrospective analysis of falls at the hospital, Children’s recently was able to predict the patients who fell 69% of the time and correctly predicted those who would not fall 84% of the time.
The predictors of falls for children are different from what you might be familiar with in elderly patients. For example, an intravenous (IV) line actually makes falls less likely for a child. An IV line is considered a fall risk in elderly patients because they may get tangled in it or have difficulty moving the IV pole as they walk, but children seem to be more intimidated by the IV line and don’t want to move while it is attached.
Also, the research suggested that medications are not as predictive of falls in a pediatric population as they are in elderly patients. Only seizure medications were predictive among children, Graf says.
Sedatives, analgesics, and other medications did not result in more falls the same way you would expect in an elderly population. But she explains that part of the reason may be that children on pediatric wards are watched more closely after surgery and when treated with strong medications.
Graf and Ward describe these risk factors for falls among pediatric patients:
- Gender (Boys fall almost twice as much as girls.)
- Longer lengths of stay
- Secondary diagnosis
- Communication deficits
- Confusion
- Developmental delays
- Weakness
- Physical therapy or occupational therapy
- Gait disorders
- Balance disorders
- Assistant device
- Anti-seizure medication
- Orthopedic diseases
- Neurological disorder or seizures
The research at Children’s also revealed that certain factors were protective against falls, including being in the hospital for general surgery or infectious disease, having an IV line, and having parents present with the child.
Pediatric falls require different strategies, not same old thing Falls among elderly patients are high on the priority list for any risk manager, but what about your patients on the other end of the spectrum? Are you doing all you can to prevent falls among your youngest patients?Subscribe Now for Access
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