FALL PREVENTION AND

MANAGEMENT

Digracia L. Manatiga RN, PhD

 INTRODUCTION
Falls are the most common cause
of injury leading to emergency
department visits.
Risks of Fall
elderly, adult and children
(community & hospital).
Children fall as they grow, develop
coordination and new skills are
often unaware of their limitations.
 AIM
 The intention of this guideline is:
 to raise awareness and educate nursing staff
and the multidisciplinary team of the
importance of maintaining a safe
environment for all patients;
 assist with identifying patients who are high
risk of fall;
 provide the tools to educate families and
carers of the potential risk of falls
 outline strategies to develop individualized
management plans to reduce risk for high
risk patients.
 DEFINITION OF TERMS
◦ Fall - A fall is an event which results in a
person coming to rest inadvertently on the
ground or floor or other lower level.
◦ Anticipated falls - may occur when a
patient feels or forsee that she or he is at
risk of falls.
◦ Unanticipated falls - occur when the
cause of the fall is not reflected in the
patient's risk factor for falls, conditions exist
which cause the fall, yet these are not
predictable (e.g., the patient faints
suddenly).
 DEFINITION OF TERMS
◦ Accidental falls - occur when a patient
falls unintentionally, usually as a result
of tripping or slipping, as a result of
equipment failure or other
environmental factors. Patients cannot
be identified as being at risk for falls
prior to this type of fall. 
◦ Risk assessment tool - a conceptual
framework that organizes knowledge on
the etiology of predicting falls.
Maintaining a safe environment for all patients

Allpediatric patients are

considered at risk of falling .
◦ A safe environment should be
maintained for all patients within the
hospital.
Standard safety measures should
be put place for all patients
regardless of identified risk.
Maintaining a safe environment for all patients

◦ Patients are nursed in an appropriate bed; children 2

years and under should be nursed in a cot (crib)
◦ Orientate all patients, parents/carers to room and
ward
◦ Keep beds in low position with brakes on and bed
ends in place
◦ Side rails and cot sides are raised for appropriate age
and patient groups
◦ Appropriate  non slip footwear for ambulating patients
◦ Nurse call within reach; educate patients and families
on its functionality
◦ Maintain adequate lighting in child's room; low level
lighting at night.
Maintaining a safe environment
for all patients
◦ Keep floors clear of clutter including equipment and
toys
◦ Secure and supervise all children with a safety belt
or harness in wheelchairs, highchairs, strollers, infant
seats and any specialist seating
◦ Children on trolleys are always under the immediate
and direct supervision of a staff member or a
caregiver
◦ Infants  in an incubator have portholes securely
fastened and door closed unless directly attended 
◦ Hourly rounding will support the provision of
proactive care such as the need for assistance to the
bathroom
 Maintaining a safe
environment for all patients
◦ Assist unsteady patients with ambulation;
refer to physiotherapy notes where
available
◦ Place necessary items a patient may need
within reach (drinking water, phone, etc)
◦ Patients who have received sedation or
general anaesthetic may be unsteady and
require supervision
◦ Ensure equipment is well maintained and
serviced appropriately (such as wheelchairs
and commodes)
 Educating families and carers

Half of falls incidents within the hospital

occur when a parent or carer is present.
Whilst most parents are aware of
maintaining a safe environment for their
children in the home environment, many
are unaware of the environmental risks
when in hospital due to being in an
unfamiliar environment accompanied with
increased levels of anxiety related to
hospital admission.
Educating families and carers
The hospitalization of children
provides an opportunity to reinforce
parent/carer information and
education concerning normal
psychological and motor
development of small children,
which is related to falls risks and
other hazards both inside and
outside hospital.
 Parents/carers should be
encouraged to:
◦ Reinforce hospital orientation with their
child

◦ Provide non slip footwear for their child

whilst in hospital - no mobilizing in socks

◦ Maintain physical contact with infant when

cot sides are down, when bathing or
weighing their infant

◦ Assist their child to the toilet when

appropriate
 Parents/carers should be
encouraged to:
◦ Use bed rails or cot sides where
appropriate when leaving child's bedside,
even for short periods.

◦ Inform nursing staff when their child is

unattended

◦ Keep infant or child in a suitable bed

◦ Familiarize parent to ensure they

 Risk Assessment

◦ All patients have a falls risk assessment

completed using the Little Schmidy Falls
Risks Assessment Tool completed at the
following stages:
◦ On admission or as soon as after the
admission
◦ Daily or when a patient's condition changes
◦ When the patient is transferred from one
ward/department to another
◦ Following a fall incident.
 Risk Assessment

The falls risk assessment tool does

not replace clinical judgment, if a
patient does not present with a
high risk score but is thought to be
high risk by medical or nursing
staff, allied health, parents or
carers extra precautions to protect
such patients should be
documented and actioned. 
Factors influencing risk
include:
◦ Environmental Issues: Are a common
cause of falls are inappropriate use of
side rails, equipment clutter, wet floors,
nurse call buttons out of patient reach or
the use of faulty equipment.
◦ Age: Incident data identified the
adolescent group (10-17 years) have the
highest risk of falls in hospital closely
followed by the toddler group (1 -2
years).
 Factors influencing risk
include:
◦ Medical Diagnosis: Various medical
conditions may increase a child's risk of
falling. Some high risk diagnosis includes
drop seizures, severe ataxia, epilepsy
surgery or patients who have had a
craniectomy.
◦ Mental State: Altered mental state is
the most commonly identified risk factor
for falling and is perhaps the most
difficult to manage in terms of
minimizing the risk of falling.
Factors influencing risk
include:
◦ Mobility: Impaired mobility and
orthopeadic restrictions are key
potential fall risk factors, interventions
such as non slip footwear, supervising or
assisting with transfers can reduce risk
◦ Elimination: Special toileting needs are
a factor for increased risk of falling.
Simple strategies such as regularly
checking patients and toileting patients
regularly will help minimize risk.
 Factors influencing risk
include:
◦ Bedrest: The majority of falls occur at the
patient's bedside, interventions such as ensuring
the bed is in a low position, the brakes are locked,
appropriate use of bed rails and ensuring patients
can reach necessary items will reduce the risk of
falling
◦ Medications: Use of medications such as
Barbiturates, Phenothiazines, Sedatives,
Hypnotics, Antidepressants, Laxatives and
Diuretics may increase the risk of falls. Care
should be taken to check the patient regularly
following administration and inform the
parents/carers of possible associated side effects.
 Factors influencing risk
include:
◦ Length of Stay: Incident data shows
that most of patients who fall do so in the
first 5 days of admission and have had
previous admissions to hospital.
◦ History of Falls: Patients who have a
history of falls in hospital or at home have
an increased risk of falling again,
appropriate precautions should be
implemented.
 Management 

Standard safety measures should

be put in place for all patients
regardless of the risk identified.

For all patients identified as high

risk, must be
commenced/MONITORED .
 Management 

The plan will be developed in

collaboration with the child's parent
or carer and will be specific to the
patient's individual needs.
 Management
A physiotherapist can advise as to how to
safely support the patient during
positioning, transfers, standing, walking and
use of mobility aids.

An occupational therapist can ensure safe

setup of the ward bedroom, bathroom and
toilet to minimize falls risks and recommend
management techniques/assistive
equipment for self-care tasks.
 Management
In the event of the occurrence of a fall:
◦ Ensure patient safety
◦ Provide immediate supportive action for the child
◦ Conduct a physical examination, measure and
document vital signs
◦ Commence neurological observation if the child's
head was the first point of impact
◦ Do not move the patient until injuries are
identified
◦ Notify appropriate medical staff
◦ Ensure safe transfer back to bed, consider using
a hoist if necessary
 Documentation of a fall event

◦ Record the incident, including:

description of event (location, activity
occurring, time, who was present),
assessment findings, interventions
and patient outcomes, notification of
the incident to the parent.
 Documentation of a fall event
Report the incident through the
hospital incident reporting system.
All falls, including near misses
should be reported. The information
from reported falls is used to gain
insight of the causes of falls for
patients to improve the local falls
prevention program.  
 Management
◦ The Medical staff needs to inform the
parents if they are not present that: 
 A fall has occurred:
 What factors contributed to the fall
 Outcome of post-fall assessment
 What additional protective measures
have been put in place
 Considerations for
For
Discharge
this patient group the following
should be considered:

◦ Parent/carer education, tips and

advice on how to manage their child
in the home environment
 Considerations for
Discharge
◦ An Occupational Therapy referral -
to assist parents and carer in the safe
setup of the home environment and
recommend management
techniques/assistive equipment for self
care tasks.
◦ A Physiotherapy referral - to educate
parents and carers how to safely support
their child during positioning, transfers,
standing, walking and use of mobility
aids.
References:
◦ Austin, D. (2017) Predicting and Preventing Falls in the Hospital, Science of Caring,
University of Science California San Francisco.
◦ Cooper, C L & Nolt, J. D. (2007) Development of an evidence-based fall prevention
program. Journal of nursing care Quality, 22(2), 107-112
Clinical Excellence Commission. (2014), Falls Prevention, Health, New South Wales
Government.
◦ Franck, L.S., Gay, C. L., Cooper, B., Ezrre, S., Murphy, B., Chan, J. S-L., Buick, M., Meer, C.R.
The Little Schimdy Pediatric Hospital Fall Risk Assessment Index: A diagnostic accuracy
study. International Journal of Nursing Studies, March 2017. 68, pp 51 – 59.
◦ Hill-Rodriguez, D., Messmer, P R., Williams, P D., Zeller, R A., Williams, A R., Wood, M.,
Henry, M.The Humpty Dumpty Falls Scale: A Case-Control Study. Journal for Specialist in
Paediatric Nursing. January 2009. 14(1) 22 -32
◦ Harvey, K., Kramlich. D.,Chapman. J., Parker. J., Blades. E. Exploring and evaluating 5
paediatric falls assessment instruments and injury risk indicators: an ambispective study in
a tertiary care setting. Journal of Nursing Management. July 2010. 18(5). 531-541.
◦ Jamerson, J., Adlard, K., Akre, M., Barton, S J., Bennett, C., Brewer, M A., Bufe, G., Cooper, C
L., Fields, H W., Graf,  E., Kerby, R., Hill-Rodriguez, D.Paediatric falls: State of
Science.Paediatric nursing July-August 2009. 35(4),227-231
◦ Keefe, S. Reducing Falls in Paediatrics - Ongoing assessment and family educationare
essential to ensuring safety in the inpatient setting. 2011. 7(6), 7
◦ Mc Williams, J R.Paediatric Fall Risk Assesment Tool for home health practice. Home Health
Nurse February 2011. 29(2), 98-105
◦ Morse, J.M. (2002) Enhancing the safety of hospitalisation by reducing patient falls.
American Journal of infection Control. 30(6), 376-380.