Authors (including presenting author) :
Au SC, Wong KP
Affiliation :
Nursing Service Division, Hong Kong Children's Hospital
Introduction :
Falls are the leading cause of unintentional injury to children and remain a major public health concern around the world. Paediatric patients have the additional risk of falling due to their stage of growth and development, and there is considerable disquiet during hospitalization. Patient fall rate in 2Q2020 showed a marked increase from 0.12 to 0.85 in Hong Kong Children’s Hospital (HKCH). Post fall investigations performed and found that most children fell with their parents in attendance and despite interventions in place. Inadequate staff alertness on patients at risk was another contributing factor. Special effort to enhance effective fall prevention would be demanded for improving this issue.
Objectives :
To establish a series of fall prevention activities to 1) arouse the awareness of fall prevention to staff and parent/carers, 2) involve the participation of patients and parent/carers to the program, 3) enforce staff compliance and 4) reduce fall incidents in HKCH
Methodology :
The program was carried out over a 10-month period from June 2020 to March 2021.
1. Empowerment
Nursing staff were invited to formulate working group, revision of the existing fall preventive measures and root causes of recent fall incidents, and the proposal of tailor-made preventive measures in the beginning of the program. Supporting staff were nominated from different wards and entitled as “Fall Prevention Captains” upon completion of a 3-hours intensive training. They were committed to assist in promulgation, implementation, maintaining standard, monitoring compliance and acting as a role model of the team in fall prevention.
2. Engagement
Fall Prevention Coloring Competition was the second stage interactive activity to enhance the alertness on fall prevention for patients and parent/carers. With the vigorous promotion by our captains, more than 30 patients and parent/carers participated the coloring competition. Hospital management team was also engaged as the selection panel to join in the program. A bilingual education pamphlet and poster on fall prevention were introduced and strategically distributed to caregivers upon admission and positioned at the cubicles and corridor of all the wards. Parent/carers agreed that the poster and pamphlet served as an effective reminder and communication method between nurses and them and also among parent/carers of the child.
3. Recognition and Sharing
Against all odds under Covid-19 pandemic, the Ceremony cum Award Presentation of the HKCH Fall Prevention Program 2020/2021 was conducted on 22 March 2021 successfully. Statistic of fall incidents since the start of the program was reported. Merit Certificate was granted to all Fall Prevention Captains to recognize their contribution. Due to the visiting policy at that time, an exhibition of 3 display boards specially designed to post up the art works of the winners was arranged to share with our staff and children. Winners were called back individually to receive the award in front of their art works with photo taken.
Result & Outcome :
Effectiveness of the fall prevention program in HKCH was shown by drastically dropped fall rate from 0.85 to 0.11 after the program started and maintained average 0.285 in the following 3 quarters.
The awareness on fall prevention of staff, patients and parent/carers’ was efficaciously aroused. All participants responded that they were happy to be a part of the program.
Paediatric fall prevention is a focal point of nurse led endeavors in HKCH. The measures of the program with extensive coverage of different stakeholders has been implemented, tested and proven to be an effective tool in the prevention of fall injury. Engagement with every staff member was the key element in implementing practice change. Communication and cooperation with parent/carers was essential in preventing fall incidents in a children’s hospital. It was a milestone on fall prevention to minimize the risk of fall during hospitalization of patients in HKCH.
