Nurse's interventions in preventing falls in hospitalized children: scoping review

Brás, Alexandra Margarida Ribeiro; Quitério, Margarida Maria de Sousa Lourenço; Nunes, Elisabete Maria Garcia Teles

doi:10.1590/0034-7167-2019-0409

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Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (suppl 6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0409 copy

Nurse's interventions in preventing falls in hospitalized children: scoping review

Intervenciones del enfermero en la prevención de caídas en el niño hospitalizado: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

map both nursing interventions for the prevention of falls in paediatric age during hospitalization and the instruments for assessing the risk of falls in paediatrics.

Methods:

scoping review according to the protocol of Joanna Briggs Institute, with acronym PCC (P - children, C - fall preventive nursing interventions and instruments for assessing the risk of falling, C - hospital admission), in three sources of information (EBSCO, PubMed and SciELO).

Results:

the sample consisted of seven articles. The education of the child/family is the basis of the interventions, and the instruments for assessing the risk of falling identified were: Humpty Dumpty Falls Scale, GRAF PIF, CUMMINGS, I'M SAFE and CHAMPS.

Conclusions:

the education of children/parents on preventive measures is important and should be reinforced during hospitalization, using different methodologies. The Humpty Dumpty Falls Scale was the most analyzed.

Descriptors:
Fall; Prevention; Nursing; Paediatrics; Risk

Title	Author	Year	Country	Review / Study
An Integrative Review of Paediatric Fall Risk Assessment Tools ⁽²²22 DiGerolamo K, Davis KF. An integrative review of pediatric fall risk assessment tools. J Pediatr Nurs. 2017;34:23-28 doi: 10.1016/j.pedn.2017.02.036 https://doi.org/10.1016/j.pedn.2017.02.0... ⁾	DiGerolamo K, Davis KF	2017	USA	Integrative review
Competencies of the Nurse in the Prevention of Falls in Children in the Light of the Galway Consensus ⁽²⁶26 Gurgel S, Ferreira A, Sandoval L, Araújo P, Galvão M, Lima F. Competências do enfermeiro na prevenção de quedas em crianças á luz do Consenso de Galway. Texto Contexto Enferm. 2017;26(4). doi: 10.1590/0104-070720170003140016 https://doi.org/10.1590/0104-07072017000... ⁾	Gurgel, S., Ferreira, A., Sandoval, L., Araújo, P., Galvão, M. e Lima, F.	2017	Brazil	Quantitative - Cross-sectional description
Development of a Paediatric Fall Risk And Injury Reduction Program ⁽²⁰20 Kramlich DL, Dende D. Development of a pediatric fall risk and injury reduction program. J Pediatr Nurs. 2016;42(2):77-82 doi: 10.1016/j.pedn.2018.02.010 https://doi.org/10.1016/j.pedn.2018.02.0... ⁾	Kramlich DL, Dende D.	2016	USA	Qualitative
Impatient Falls in Freestanding Children's Hospitals ⁽²¹21 Jamerson P, Graf E, Messmer P, Fields H, Barton S, Berger A, et al. Inpatient Falls in Freestanding Children's Hospitals. J Pediatr Nurs[Internet]. 2014 [cited 2018 Apr 24];40(3):127-35 Available from: https://pubmed.ncbi.nlm.nih.gov/25134226/ https://pubmed.ncbi.nlm.nih.gov/25134226... ⁾	Jamerson, P, et all	2014	USA	Quantitative - Cross-sectional description
Paediatric Falls: Effect of prevention measures and characteristics of paediatric wards ⁽²³23 Fujita Y, Fujita M, Fujiwara C. Pediatric Falls: effect of prevention measures and characteristics of pediatric wards. Japan J Nurs Sci. 2013;10:223-231 doi:10.1111/jjns.12004 https://doi.org/10.1111/jjns.12004... ⁾	Fujita, Y., Fujita, M., Fujiwara, C.	2013	Japan	Quantitative - Cross-sectional description
A case-control study of paediatric falls using electronic medical records ⁽²⁴24 Messmer PR,Williams PD, Williams AR. A case-control study of pediatric falls using electronic medical records. Rehabil Nurs. 2013;38(2): 73-79 doi: 10.1002/rnj.73 https://doi.org/10.1002/rnj.73... ⁾	Messmer PR, Williams PD, Williams AR.	2013	USA	Quantitative - Control case
An interdisciplinary momentary confluence of events model to explain, minimize, and prevent paediatric patient falls and fall-related injuries ⁽²⁵25 Ryan-Wenger NA, Dufek JS. An interdisciplinary momentary confluence of events model to explain, minimize, and prevent pediatric patient falls and fall-related injuries. J Spec Pediatr Nurs. 2013;18(1):4-12 doi:10.1111/jspn.12009 https://doi.org/10.1111/jspn.12009... ⁾	Ryan-Wenger NA, Dufek JS.	2013	USA	Integrative review

Title	Results
Competencies of the Nurse in the Prevention of Falls in Children in the Light of the Galway Consensus (2017) ⁽²⁶26 Gurgel S, Ferreira A, Sandoval L, Araújo P, Galvão M, Lima F. Competências do enfermeiro na prevenção de quedas em crianças á luz do Consenso de Galway. Texto Contexto Enferm. 2017;26(4). doi: 10.1590/0104-070720170003140016 https://doi.org/10.1590/0104-07072017000... ⁾	- Most used fall prevention nursing interventions were: inform whether the child can walk or not (97.5%), educate the child/caregiver about the risk of falling (92.5%), assess the risk of falls at the moment after admission (92.5%), arrange for transportation on a stretcher or wheelchair (95%), keep one of the crates lifted from the cradle during the child's clothes/diaper change (92.5%). - Less used fall prevention nursing interventions were: checking the prescription of medication that alters mobility and balance (72.5%), registering the child's risk of falling in the computer process as well as the interventions carried out in its prevention (72.5%), report the fall incidents (72.5%).
Development of a Paediatric Fall Risk And Injury Reduction Program (2016) ⁽²⁰20 Kramlich DL, Dende D. Development of a pediatric fall risk and injury reduction program. J Pediatr Nurs. 2016;42(2):77-82 doi: 10.1016/j.pedn.2018.02.010 https://doi.org/10.1016/j.pedn.2018.02.0... ⁾	- Use an instrument to assess the risk of falls in paediatrics. - Guide all health professionals towards the implementation of preventive measures.
Impatient Falls in Freestanding Children's Hospitals (2014) ⁽²¹21 Jamerson P, Graf E, Messmer P, Fields H, Barton S, Berger A, et al. Inpatient Falls in Freestanding Children's Hospitals. J Pediatr Nurs[Internet]. 2014 [cited 2018 Apr 24];40(3):127-35 Available from: https://pubmed.ncbi.nlm.nih.gov/25134226/ https://pubmed.ncbi.nlm.nih.gov/25134226... ⁾	- Presence of the caregiver as a strategy: 77% of the children had an adult present at the time of the fall, of which 90% actually witnessed the fall. - Strategies for reducing the risk of falls: signalling children (87%) at risk of falling; existence of risk communication (66%), risk registration in the care plan (49%), risk signalling in the child's identification (21%) and the use of another identification method (14%).
Paediatric Falls: Effect of prevention measures and characteristics of paediatric wards (2013) ⁽²³23 Fujita Y, Fujita M, Fujiwara C. Pediatric Falls: effect of prevention measures and characteristics of pediatric wards. Japan J Nurs Sci. 2013;10:223-231 doi:10.1111/jjns.12004 https://doi.org/10.1111/jjns.12004... ⁾	- The fall rate was lower in units that implemented the following measures: "sharing information with the high-risk patient", "removing obstacles in the passage circuits", "using an information leaflet to educate children/caregivers about the proper use of crib/bed rails/protections", "use of a fall risk assessment tool", "select the type of bed according to the child's characteristics", "help in walking the child with a high risk of falling", "keep the unit organized", "educate the child/caregiver more than once". - The fall rate was significantly higher in the units that implemented the measure "educate, only in verbal form, about the correct use of bed rails" in relation to those that did not implement it.
An interdisciplinary momentary confluence of events model to explain, minimize, and prevent paediatric patient falls and fall-related injuries (2013) ⁽²⁵25 Ryan-Wenger NA, Dufek JS. An interdisciplinary momentary confluence of events model to explain, minimize, and prevent pediatric patient falls and fall-related injuries. J Spec Pediatr Nurs. 2013;18(1):4-12 doi:10.1111/jspn.12009 https://doi.org/10.1111/jspn.12009... ⁾	- Start with the risk assessment of falls based on scores of risk assessment tools for falls. - Important to notify the cases of fall.

Title	Results
An Integrative Review of Paediatric Fall Risk Assessment Tools (2017) ⁽²²22 DiGerolamo K, Davis KF. An integrative review of pediatric fall risk assessment tools. J Pediatr Nurs. 2017;34:23-28 doi: 10.1016/j.pedn.2017.02.036 https://doi.org/10.1016/j.pedn.2017.02.0... ⁾	- Humpty Dumpty Falls Scale, created by Hill Rodrigues (2009) (seven items evaluated: age, sex, diagnosis, cognitive impairment, environmental factors, response to surgery or sedation/anaesthesia, use of medications). - GRAF PIF, created by Graf, (2011). Five items: length of stay, IV/free heparin block, physical/occupational activity, medication, orthopaedic diagnosis. 75% sensitivity and 78% specificity. - CUMMINGS has six items: history of falling, physical function, cognitive/psychological impairment, need for equipment and medication. Three levels of risk (no risk, low risk, high risk); there is no data on sensitivity or specificity. - I'M SAFE, created by Neiman et al. (2011) assesses six items, similar to the HFDS scale, and the score would be three levels (low, moderate and high risk), with no risk considered. - CHAMPS, created by Ramus et al. (2006) assesses six items: altered state of consciousness, history of previous fall, age less than 3 years, mobility problems, parental involvement and safety measures in place. 75% sensitivity and 79% specificity. - The instruments should be used in the initial assessment, but they cannot be out of step with the child's specificity.
Development of a Paediatric Fall Risk And Injury Reduction Program (2016) ⁽²⁰20 Kramlich DL, Dende D. Development of a pediatric fall risk and injury reduction program. J Pediatr Nurs. 2016;42(2):77-82 doi: 10.1016/j.pedn.2018.02.010 https://doi.org/10.1016/j.pedn.2018.02.0... ⁾	The fall risk assessment scale was the Humpty Dumpty Falls Scale, which includes the risk factors for falls in paediatrics.
Impatient Falls in Freestanding Children's Hospitals (2014) ⁽²¹21 Jamerson P, Graf E, Messmer P, Fields H, Barton S, Berger A, et al. Inpatient Falls in Freestanding Children's Hospitals. J Pediatr Nurs[Internet]. 2014 [cited 2018 Apr 24];40(3):127-35 Available from: https://pubmed.ncbi.nlm.nih.gov/25134226/ https://pubmed.ncbi.nlm.nih.gov/25134226... ⁾	Risk assessment instruments used and their sensitivity: GRAF-PIF, 37%; Humpty Dumpty Falls Scale, 52%; CHAMPS, 66%.
Paediatric Falls: Effect of prevention measures and characteristics of paediatric wards (2013) ⁽²³23 Fujita Y, Fujita M, Fujiwara C. Pediatric Falls: effect of prevention measures and characteristics of pediatric wards. Japan J Nurs Sci. 2013;10:223-231 doi:10.1111/jjns.12004 https://doi.org/10.1111/jjns.12004... ⁾	- Humpty Dumpty Falls Scale assesses six risk factors. 84% sensitivity and 24% specificity. - GRAF PIF: assesses five risk factors (previously mentioned). 75% sensitivity and 78% specificity.
A case-control study of paediatric falls using electronic medical records (2013) ⁽²⁴24 Messmer PR,Williams PD, Williams AR. A case-control study of pediatric falls using electronic medical records. Rehabil Nurs. 2013;38(2): 73-79 doi: 10.1002/rnj.73 https://doi.org/10.1002/rnj.73... ⁾	- CHAMPS evaluates six items (previously mentioned) - GRAF PIF evaluates five items (previously mentioned) - Humpty Dumpty Falls Scale evaluates six items. 57% sensitivity and 39% specificity.

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[1] Corresponding author: Alexandra Margarida Ribeiro Brás E-mail: alexandra.bras@hotmail.com