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Purpose: The primary goal is to establish an interdisciplinary process for the assessment and prevention of falls within the Day
Hospital Feeding. A secondary aim is to increase awareness of patient safety within the feeding team.
Background: Pediatric safety remains a high priority. In an effort to support the National Patient Safety Goal, for establishing a
Fall Reduction Program, strategies have been instituted to decrease falls risk amongst inpatient pediatric patients. Factors shown to
contribute to falls in the hospital setting are not necessarily transferable in other settings. Children in an ambulatory setting face other
types of hurdles. Challenges associated with the unique needs of children in an ambulatory day hospital setting include: length of
time spent in the program (both in meals and downtime); patient characteristics (development, modulation/arousal level, and level of
refusal behaviors); and environmental factors (navigating to and from meals as well as safe seating during meals). Specific strategies
for promoting a culture of safety through a focus on a falls risk prevention program will be addressed. A consequence of our falls risk
reduction program was an increase in awareness of the importance of teamwork towards patient safety.
Methodology: A review of the literature revealed a dearth of evidence in the area of ambulatory pediatric falls, risk assessment and
prevention. There are several pediatric validated screening tools for the inpatient setting and one for the home setting. A taskforce
consisting of nursing, occupational therapy, psychology and feeding specialists, identified gaps in practice for the assessment and
communication about children at risk for falls. In order to meet the unique needs of our population, a modified version of falls
risk screening tool was created, which established good inter-rater reliability between nursing and occupational therapy. A tieredintervention
approach was developed based on patient observation, chart review, and a focused parent survey. This includes three
levels of risk: no increase above minimal risk, minimal increase above minimal risk, and moderate increase above minimal risk. A
protocol and job aide was created, as well as a staff education plan, including a self-learning module on falls risk assessment and
prevention. The results of the screen were incorporated in our bi-weekly rounds, as well as in daily communication regarding newly
identified falls risk concerns.
Conclusions: Implementing a modified falls risk prevention program within an ambulatory Day Hospital Feeding program is not
only feasible, but necessary in order to establish an increased awareness of safety. By utilizing this framework as a screening process
to identify safety concerns, a more uniform safety dialogue emerged. Each member of our team became safety champions. Team
members reported an increased confidence with implementing and discussing safety guidelines with parents and patients and an
increased understanding of how to identify and modify scenarios that could eventually lead to injuries. In general, by identifying this
emphasis of safety the entire Day Hospital Feeding program demonstrated a shift of renewed awareness and confidence to establish
and maintain safe procedures for patient transportation and parent education against falls. Future study is needed to evaluate the
efficacy and to establish validity of a modified falls risk screen within an ambulatory setting.