Implementation of a Fall Prevention Bundle on a Pediatric Neurology Unit

Abstract

Evidence/Background: Many times the nursing staff may not be readily available at the bedside to prevent falls. Falls continue to place a tremendous burden on patients and financial burden on the institution. A multifaceted approach to decrease falls in a pediatric hospital setting was implemented with a fall bundle. Included in this fall bundle is the Humpty Dumpty Fall Scale, a validated and reliable tool that is specifically sensitive to neurology patients and an education plan focused on families and staff. The Humpty Dumpty Fall Scale included a wide variety of medications and anesthesia/sedation influences to assess the risk of falls. Education to families has been identified as important in preventing falls. Local Problem: Pediatric patients are at an increased risk for falls in the hospital setting. Nursing staff and caregivers play an important role in preventing falls yet little is known on how to best prevent falls rates in the pediatric acute care setting through evidence- based interventions. The Joint Commission, the certifying body for health organization, now requires that a fall prevention program be implemented to prevent falls in all hospital setting. The purpose of this quality improvement project is to decrease the pediatric fall rate through the implementation of a pediatric fall bundle. Intervention: This quality improvement project took place on an 18-bed pediatric acute care unit at a large freestanding pediatric facility on the East Coast. The Neurosurgical unit pediatric patients were included in this quality improvement project. The pediatric fall bundle included implementation of education on fall prevention in children to staff and caregivers, the introduction of a new pediatric fall risk assessment scale, the Humpty Dumpty Fall Scale, and fall risk bracelet/band identifiers. Results: Quantitative data comparing fall risk and occurrence of falls was collected to assess the effectiveness of the fall bundle on the neurosurgical unit. Sixty patients met the inclusion criteria and were included in this quality improvement project. All sixty patients risk for a fall was assessed using the Humpty Dumpty Fall Scale. In 2018 there were a total of seven falls reported on the neurosurgical unit. Prior to implementation of the fall bundle, four falls were reported on the neurosurgical unit. During the implementation of the fall bundle, there was a decrease in fall rates with only one reported unwitnessed fall resulting in no injuries. Two additional falls occurred post implementation of the fall bundle on the unit. Conclusions: This DNP project was intended to improve the quality of patient care and promote fall safety to pediatric patients admitted to the neurosurgical unit. There was a decrease in rate of falls on the unit during implementation. This QI project increased awareness of neurological assessments pertaining to patient falls. Nursing staff reported including fall prevention in their daily plan of care after receiving fall prevention education. This QI project promoted a change in practice that heightened fall risk awareness and included fall risk education, a pediatric-specific fall scale, and patient identifiers in an effort to decrease the fall rate of patients on the neurosurgical unit.