A Closer Look at Pediatric Falls A CHCA Multi-site study

A Closer Look at Pediatric Falls A CHCA Multi-site study Patricia A. Jamerson PhD, RN, Patricia R. Messmer, PhD, RN-BC, FAAN Cindy Asher, CNS, RN, Kat...
2 downloads 0 Views 3MB Size
A Closer Look at Pediatric Falls A CHCA Multi-site study Patricia A. Jamerson PhD, RN, Patricia R. Messmer, PhD, RN-BC, FAAN Cindy Asher, CNS, RN, Kathie Arbuckle, MPA, MT, (ASCP), CPHQ Kathleen Adlard, MN, RN, Sharon Barton, PhD, APRN-BC, Crystal Bennett, DNSC, RN, Anne M. Berger, PhD, MBA, RN, CPHQ Carole Cooper, MHA, BSN, RN, CPN, Heidi Fields, MSN, RN, PNP Michele Fix, BSN, RN, Elaine R. Graf, PhD RN, NE-BC Matt Hall, PhD (CHCA) Jacqueline Harrison DNS, RN Deborah Hill-Rodriguez MSN, ARNP, PCNS-BC Francine Jones, PhD, RN Myra Martz Huth PhD, RN, FAAN , Christa Joseph, MSN Rebecca Kerby, RN, BSN, Linda Latta, PhD, RN, NEA-BC Amy Phillips, MSN, APRN-CNS, CCRN, Nancy Ryan-Wenger PhD, RN, FAAN Jennifer Slayton, BSN, RN, Andrea Smith, PhD, RN, CPNP Kathy Speer, PhD, RN, CPNP, Kristen L. Straka, MSN, RN, CPN Carol Wright, BS, RN, MAHSM, Denise Young, MSN, RN, CPN

Problem • The Joint Commission (JC) and Institute of Medicine (IOM) identify inpatient falls as a significant patient safety risk • However research regarding falls in in-patient pediatric settings is limited

Review of Literature • AHRQ Health Care Innovations Exchange: Bundle of interventions targeting high risk patients reduces falls and fall –related injuries on medical-surgical units www.innovations.ahrq.gov/popup.aspx?id=2611&type=1&nam e=print accessed 5/12/2010/ • Britton, J.W. (2005). Kids can’t fly: preventing fall injuries in children. State Medical Society of Wisconsin, 104(1), 33-36. • Child Health Corporation of America (2009). Pediatric falls: State of the science. Pediatric Nursing 35(4), 227-231 • Cooper, Cl & Nolt, J.D (2007). Development of an evidencebased pediatric fall prevention program, J Nurs Care Qual 22(2), 107-112. • Graf, E. (2008). Pediatric fall risk assessment & classification: Two hallmarks for a successful inpatient fall prevention program," SPN News, 17 (2), pp 3-5. • Grenier-Sennelier, C., et al (2002). Designing adverse event prevention programs using quality management methods IJQHC, 14, 419-426.

Review of Literature • Hendrich, A, Bender, P, Nyhuis, A. (2003). Validation of Hendrich II Fall Risk Model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16(1), 9-21. • Hill-Rodriguez, D, Messmer, P., Williams, P., Zeller, R.A., Williams, P., Wood, M & Henry, M. (2008). The Humpty Dumpty Falls Scale: A case control study. JSPN 14(1), 22-32. • Lord, S.R., et al (2005). The effect of an individualized fall prevention program on fall risk and falls in older people: A randomized, controlled trial. JAGS, 53 (8). 1296-1304. • Meyers, H.& Nikoletti, S. (2003). Fall risk assessment: A prospective investigation of nurses’ clinical judgment and risk assessment tools in predicting patient falls. IJNP, 9, 158-165. • Neiman, J. & Rannie, M. I’m safe: development of a fall prevention program to enhance quality and patient safety. 8th Annual Forum NICHQ conference, Grapevine, Texas, March 11, 2009

Review of Literature • O’Connell, B., Myers, H. (2002). Research in brief. The sensitivity and specificity of the Morse Fall Scale in an acute care setting. Journal of Clinical Nursing, 11(1), 134-135. • Park, S.H., Cho, B.M., Oh, S.M. (2004). Head injuries from falls in preschool children. Yonsei Medical Journal, 45(2), 229-232. • Pillai, S.B., et al. (2000). Fall injuries in pediatric population: Safer and most cost effective management. Journal Trauma, 48(6), 1050-51. • Quigley, P., Hahm, B., Collazo, S et al (2009). Reducing serious injury from fall in two Veterans’ hospitals medical – surgical units Journal of Nursing Care Quality 24(10, 33-41. • Raszmus, I. (2006). Falls in hospitalized Children. Pediatric Nursing 32(6), 568-572.

Purpose • A retrospective multi-site study of inpatient pediatric falls in 26 Child Health Corporation of America (CHCA) was sanctioned by the CNO’s in CHCA facilities to determine prevalence, fall characteristics and related injuries • The theoretical framework was based on Donabedian's structure-process-outcome model.

Methodology • A 70-item data collection tool

– content validity was established by a group of nurses researchers/clinicians

• Sample- 26 CHCA pediatric hospitals • Exclusion – Any child over age 18

• Development age groups – – – –

Infant- 0-23 months Toddlers/pre-school- 2-4 years School-aged- 5-12 years Adolescents - 13-18 years

Methodology • Data were abstracted from occurrence reports, patient charts and staff interviews. • Data analysis included calculated prevalence rates and descriptive statistics.

Results • Over a six-month period, 782 pediatric falls in 26 facilities were reported. Percent

• Prevalence rate (95% CL)- 0.88/1000 patient days

Time of Day 40 20 0

• Development level children who fell 159 192 248 183

0:00-6:00

infants (20%) toddler/preschool (25%) school-aged (32%) adolescents (23%)

• Falls occurred every day; more on Tuesday – Between noon-6pm – 59% in the patient room, non-ICU

12:0118:00

18:0124:00

p=0.0969

40 20 0 Sun

• More Falls occurred

6:01-12:00

Day of Week Percent

– – – –

p