To describe the practices that all staff follow that help minimize fall risks for patients seen in both in-patient and out-patient departments that care for newborns, infants and children in the Shared Health/WRHA.To minimize developmentally inappropriate falls and any injury from falls.Fall: an unexpected event where a person comes to rest on the ground, object, or a lower level with or without injury.Fall Risk Factors: variables that may contribute to falls or increase risk for falls, for example developmental age, environment, medication and diagnosis.4.1 If patient is admitted at Children's Hospital, assess using the Pediatric Patient Handling and Movement form (Form # NS01188) for risk factors with mobility and transferring of the patient. Implement appropriate care plan. See Appendix A: Pediatric Fall Risk Factors and Universal Falls Precautions for additional fall risk factors to consider. 4.1.1 Complete and post the pediatric patient handling and movement sign (Form #NS01189) or the adult patient handling and movement sign (Form #NS01064) (for the mother/parent of a newborn) at the bedside or designated spot. 4.2 Verbally educate the patient and families about risks for falls while in hospital and what they can do to minimize these risks. See 7.0 Resources for patient education resources for your program. Universal Fall Precautions -see Appendix A: Pediatric Fall Risk Factors and Universal Falls Precautions for a list of precautions. Note: this list is subject to periodic review and may not be inclusive to all precautions applicable to your clinical area. 4.2.1 Document patient/parent/caregiver education related to infant/child falls safety in the medical record. 4.2.2 Document on-going infant falls assessment in the medical record.#
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For Children's Hospital, confirm availability of well-fitting non-skid footwear and ensure that if hospital clothing is too big for patient (example pants are too long), encourage family to bring in patient's clothing from home.
Orientate patient and family to hospital surroundings, bathroom and how to use the call bell.
Keep environment clear of hazards and clutter, remove unnecessary equipment from patient care environment.
Minimum hourly checks on patient, with proactive assessments of patient needs such as elimination, nutrition, and pain relief. Document risk factors in the patient record. 4.6.1 On postpartum units, pay special attention to parental exhaustion and maternal use of narcotics as risk factors for falls. 4.6.2
On postpartum units, minimize risk of falls by ensuring that infants are not carried in the parent/caregiver arms outside of the hospital room.
Assess need for additional lighting at night with patient and family.
Disconnect patient from medical equipment or tubing as soon as possible. If still required, secure tubing or cables through clothing or with burn netting, reduce tubing length and convert IVs to saline lock.
Infants/children under 3 require a crib. Side rails shall remain up while the infant/child is in the crib and secure crib canopies for all infants/children in cribs who may be capable of climbing or pulling themselves to a standing position. Fall Risk Factors:
- Developmental age or cognition, are they learning to walk, run or climb, recent changes in mentation, confusion, restlessness and those with higher activity level or impulsivity. - Mobility impairment for example -muscle weakness or unusual muscle tone and gait disturbance that can impact balance and coordination, use of assistive devices or transfer aids. - Diagnosisneurological diagnoses that can affect level of consciousness for example seizures, gastrointestinal illnesses that can increase urgency to use the bathroom, lead to dehydration, respiratory illnesses that can impact level of consciousness - Medicationany medication that has sedative side effects, for example pain medication, seizure medications and anesthetics (can affect ambulation and coordination for up to 48 hours).

# Pediatric Universal Falls Precautions
Preventative strategies need to be linked with developmental assessment of the child and engagement of the caregivers.

# APPENDIX B: Pediatric Post Fall Assessment and Management Algorithm
Patient Fall has occurred:
- Call for help if needed - Note position of patient and surrounding environment - Assess for pain, decreased sensation or numbness, airway, breathing, circulation and level of consciousness

# No Injury
Injury has occurred: Assess for degree of injury before moving the patient Suspected minor injuries include:
- Skin lacerations, bruising, broken bones of the toes or fingers Suspected major injuries include:
- Head injury, loss of consciousness - Large bone fracture like leg or arm.

# Assess for contributing factors and determine if:
- a prevention plan is needed - there is a need to notify service and document fall