paediatric falls education case study clinical excellence commission august 2014 developed by nsw...
TRANSCRIPT
Paediatric Falls EducationCase 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- 13
2
2
3
2
2
1
1
13
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 10
2
2
1
1
2
1
1
10
Day 1 Day 3
Age Score 2 2
Gender Score 2 2
Diagnosis Score 3 1
Cognitive Impairments Score 2 1
Environmental Score 2 2
OR/Sedation Score 1 1
Medications Score 1 1
TOTALS 13 10
7
ON ADMISSION Date /Time Signature
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 protocolIf 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 hazardsCurtains should be pulled back to enable full view of child, unless otherwise indicated
Ensure adequate lighting and leave nightlight on where appropriateKeep 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 unattendedAccompany the child when they are ambulatingConsider moving child closer to nurses’ stationAssess need for 1:1 general observationReview medication administration timings for childrenEngage 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 CoordinatorOR• Local Health District Paediatric CNC OR• Clinical Excellence Commission
Who do I ask for more information?
AcknowledgementsMiami Children’s Hospital (Humpty Dumpty Falls Assessment Program™)
NSW Kids and FamiliesPaediatric Falls Resources Committee Sydney Children’s Hospital Network NSLHD + CCLHD Paediatric ServicesJohn Hunter Children’s HospitalNSW Paediatric CNC Group
