Cooper and Nolt (2007) [9] | Cooper and Nolt (2007) [7] |
Pediatric Fall Prevention Program for inpatients |
|
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Humpty Dumpty sign on patient’s door
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Humpty Dumpty sticker on patient’s chart
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Meditech bulletin boards updated “Fall Risk” and dated
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Room closer to RN station
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Consider utilizing sitters, volunteers, family
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Assist with toileting At frequent, scheduled intervals
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Provide assistive devices to steady gait
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Request order for physical therapy as appropriate
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Request order for restraints as appropriate
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Document: documented in their care plan for high-risk group
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|
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Use cribs for all patients <3 years old
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Encourage skid-resistant shoes/slippers
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Assist unsteady patient with ambulation
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Manage to improve mobility
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Keep bed in the lowest position, brakes on
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Eliminate clutter in the room
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Keep call light within reach and answer promptly
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Place articles (glasses, hearing aids, mobility aids)
|
|
Hill-Rodriguez et al. (2009) [10] | Hill-Rodriguez et al. (2009) [8] |
USA |
Hill-Rodriguez et al. (2009) [ | Matched case-control design |
10] | Hill-Rodriguez et al. (2009) [8] |
Patient Falls Safety Protocol |
|
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Identify patient with a “Humpty Dumpty sticker” on the patient, in the
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-
bed, and in the patient chart
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Educate patient/parent of fall protocol precautions
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Check patient with ambulation
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Developmentally place patient in appropriate bed
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Consider moving patient closer to nurse’s station
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Assess need for one-to-one supervision
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Evaluate medication administration times
| In-patient units, PICU | 1 | , CICU | 2 |
153 |
Accompany patient with ambulation
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Remove all unusual equipment out of the room -
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Protective barriers to close off spaces, gaps in the bed -
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Keep door always open unless patient is directly attended -
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Document in nursing narrative teaching and plan of care -
| 153 |
|
|
|
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Orientation to room
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Bed in low position, brakes on
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Siderail *2 or 4 up, assess large gaps
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Nonskid footwear
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Assess elimination needs, assist as needed
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Call light within reach, educate patient/family
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Environment clear of unusual equipment, furniture, and hazards
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Assess for adequate lighting, leave night light on
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Educate patient and parent
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| Humpty Dumpty Procedure: Low/High program |
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Document fall prevention
| 2005–2006 |
-
| Fall events: Odds ratio = 1.87;
confidence interval = 1.01, 3.53
( | p | = 0.03) |
|
|
Neiman et al. (2011) [11] | Neiman et al. (2011) [9] |
USA |
Retrospective case-control study |
Inpatient encounter |
Neiman et al. (2011) [11] | Neiman et al. (2011) | 59 |
177 |
I’M SAFE fall risk tool/prevention/evaluation |
[9 | January 2004–September 2005 |
Decreased fall rate = 0.67/1000 patient days |
>0.51/1000 ( | p | = 0.015) |
] |
I’m SAFE fall Prevention Program |
|
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I’m Safe Fall Assessment tool by EMR, hourly rounding, one to one
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observation
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Safe room set up (bedside signage, bed brake, bed in low position, side rail up)
|
|
Low-risk intervention
|
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Family education
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Bed in low position, side rail up, bed brakes on, clutter in room minimized
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Moderate risk intervention
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Assist with activity/mobility
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Periodic assessment of elimination
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Periodic orientation
|
|
Lyren et al. (2013) [12] | Lyren et al. (2013) [10] |
USA |
QI project |
Children’s hospitals |
Lyren et al. (2011) [12] | Lyren et al. (2011) | 45 |
127 |
Ohio Children’s Hospital Association |
January 2010–October 2012 |
Decreased severe safety event (70/127->18/45) |
[10] |
Collaborative Organizational Framework-High Reliability Implementation |
The error prevention task force
The leadership methods task force
The cause analysis task force
The lessons learned task-communication, risk management
All organizations have developed mechanisms to routinely share safety stories
The safety governance task forces |
|
Lee et al. (2013) [13] | Lee et al. (2013) [11] |
Singapore |
Experimental study |
Pediatric wards |
30 (caregivers) |
None |
Lee et al. (2013) [13] | Lee et al. (2013) [11] |
The JBI Practical Application of Clinical Evidence System (PACES) |
|
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Perform reinforcement and PFE 1 on fall prevention
|
| | The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) Programmes |
| March–June 2011 |
|
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Develop a poster on fall prevention
|
| (1) The fall risk preventative interventions and high-risk fall event did not differ between the experimental and control groups ( | p | = 0.110) |
|
(2) The behavior of patients at risk of fall did not differ between the experimental and control group ( | p | = 0.039) |
Rouse et al. (2014) [14] | Rouse et al. (2014) [12] |
USA |
Rouse et al. (2014) [14] | Rouse et al. (2014) | QI project |
Pediatric unit |
Not described |
Not described |
Patient Falls Safety protocol |
June 2011 |
Not described |
[12] |
Patient Fall Safety Protocol |
Similar to Cooper and Nolt’s (2007) protocol |
|
Murray et al. (2016) [15] | Murray et al. (2016) [13] |
USA |
QI project |
Pediatric ward/PICU |
Murray et al. (2016) [15] | Murray et al. (2016) [13] | 1 |
January–June 2016 |
January–June 2015 |
Fall Risk Assessment, prevention program | Plan-Do-Study-Act (PDSA) |
January–June 2016 |
Decreased fall rate 4.5% per 1000 |
Plan-Do-Study-Act (PDSA)-6-bed ward, PICU, 0–18 months, Fall Risk Assessment, Prevention program/HDFS (administered once a shift/family) and patient education, sign, orientation to the unit, environment safety, patient rounding hourly (high risk) |
|
Stubbs and Sikes (2017) [16] | Stubbs and Sikes (2017) [14] |
USA |
QI project |
Stubbs and Sikes (2017) [16] | Stubbs and Sikes (2017) [ | Inpatient pediatric neuro rehabilitation center |
2014 |
2009 |
14] |
PDSA method: interdisciplinary intervention—red light, green light |
Red Green light
Interdisciplinary care involving physical therapist, nurse manager, educator
Family training session, red-green light
Staff education/nursing staff education |
| PDSA Method: Interdisciplinary intervention-green light, green light |
Park and Ju (2017) [4] |
Pediatric fall prevention education |
Pediatric fall prevention education: Leaflet and picture book |
|