Risks, Consequences, and Incidents of Childhood Injuries

During hospitalizations, falls are amongst the highest preventable consistent adverse events. Preventing such undesirable events, enhances patient overall experience, as well as increased trust in the health care professional team (Fragata, 2011). The importance of fall prevention lies with the many serious unfavorable health outcomes it can pose on the patient. Falls have the potential increase length of hospital stay, limit mobility, independence, but can ultimately lead to health deterioration, including death. Worldwide, falls are the second leading cause of accidental death. In addition to the life-threatening health and safety risks falls have to the patient, it also as a financial impact,

Patient falls in hospitals are a critical problem and are used as a standard metric of nursing care quality. According to the Joint Commission, thousands of patients fall in hospitals each year. Approximately 30-50% of falls result in injuries and prolonged hospital stays. Any patient in a hospital is at risk for falling and certain measures should be in place to prevent this. Preventing falls and injuries are not only important for the patient, but also for their families, the hospital, health care team, and insurance companies. It is estimated the average cost of a hospital admission due to a fall is $20,000 and by 2030, an estimated $54 billion will be spent on health care costs due to falls. The purpose of this paper is to explore the risk factors of falls in hospitals and interventions used to combat this problem.

Pediatric abusive head trauma, also known as shaken baby syndrome, is a devastating form of abuse. It occurs when a young child is violently shaken. The repeated shaking back and forth motion causes the child’s brain to bounce within the skull, resulting in bruising and swelling. This intentionally inflicted injury causes trauma to the head and neck region, including cranial, cerebral, and spinal injuries. It occurs in infants and small children because the muscles of the neck region aren’t strong enough to go against the shaking force that occurs. Some make a complete recovery; others are left with debilitating handicaps, and in some cases death occurs. The Centers for Disease Control and Prevention (2012), states that among all the forms

Capan, K., & Lynch, B. (2007). Reports from the field: patient safety. a hospital fall assessment and intervention project. Journal of Clinical Outcomes Management: JCOM, 14(3), 155-160.

Nurses help to ensure patient safety, which includes preventing falls and fall-related injuries (Quigley, Neily, Watson, Wright, & Strobel, 2017). The general population is at risk for falls and fall-related injuries, more specifically the elderly, 65 and over (Quigley, Neily, Watson, Wright, & Strobel, 2017). Patient falls are one of the top events for hospitals and long-term care facilities due to loss of physical function or cognition (Quigley, Neily, Watson, Wright, & Strobel, 2017). Fall-related injuries are a serious health issue for the elderly population (Quigley, Neily, Watson, Wright, & Strobel, 2017). Nurses make a major contribution to patient safety by assessing fall risk and designing patient-specific fall prevention

A Worldwide survey of emergency room visits shows that about every 25 seconds, a young athlete visits a hospital emergency room from a sports-related injury (Loehrke and Healy, USA TODAY). Occasional bumps and bruises are expected when kids play sports, but when almost 1.4 million kids are injured and sent to hospitals its catches someone’s eye. Sprains, strains, fractures, contusions, abrasions, and concussions all top the list of ER diagnoses for kids age 6-19. That’s averaging a cost of up to 935 million a year. Many believe these are preventable (Carr, Safe Kids).

Children have multiple or prolonged exposure to trauma, experience various symptoms and reactions, and long for progressive techniques to heal their pain.

Provide mandatory, up-to-date education related fall prevention. Every single one in this facility can have the adequate capacities to prevent falls and offer education to patients, family members and caregivers regarding skills and knowledge of fall prevention. Develop policies in multifaceted and tailored strategies with evidence-based practice (Breimier, Halfens, & Lohrmann, 2015). Have more awareness and "need for individualizing the care plan and communicating the plan to those working with the patient becomes evident when implementing a fall reduction program" (Ambutas, Lamb, & Quigley, 2017, p 179). In addition, maintain consistency or accuracy in risk identification and action planning, as well as obtain patient and caregiver’s commitment to adhere to the safety plan on the daily basis (Silva, & Hain, 2017). Everyone is in the same page and conduct measures effectively and efficiently. Evaluate and assess the implementation of strategies monthly. Change and correct properly and timely to reach the aim of zero falls.

This project is part of an existing Quality Improvement Project by the organization on falls prevention, the most important aspect of a falls prevention initiative is using a standardized fall risk assessment (such as the BRIGGS Healthcare Falls Risk Assessment) to support the Quality Improvement Project. Quality Improvement projects are vital to any organization; they are data-driven, usually involve human participation. Also, it is a systematic approach, data-guided activities designed to bring about improvement in health delivery system. The fundamental obligation of health care providers and stakeholders are improving the quality of care of patients (Zaccagnini & White, 2011).

The Center for Disease Control and Prevention (2016) informs us that “health care providers play a major role in fall prevention.” The care of our elders is entrust to all employees, every team member is value and fall prevention is not a concern of only the nursing staff. Therefore, as we embarked on this quality improvement endeavor our entire interdisciplinary team (IDT) met and brainstormed to develop a preventative plan to ensure safety. The fall policy was revised from the standard event reporting guidelines to to a more detailed and specific protocol. This protocol was in addition to the normal assessment, vital signs, mandate paperwork, and the procedures of notify the physician and the responsible party. The new ground rules laid out step by step guidelines. All staff members was informed about our concern with the increase rate of falls, the goal to reduce this number and the role they play in achieving this goal. “Every health care provider should be proactive in evaluating he risk of falls in their elderly patients” (Schimke & Schimke, 2014, p. 228). Therefore, a rallying of the troops is always necessary to assure we are all on board and moving in the same direction. Also, meetings of this nature reduces resistance from the direct caregivers. As well as, provides supports to the supervisors as they enforce and oversee the changes in our procedures. According to Osuji et al,

Elimination of patient falls is not an easy task otherwise they would have been eliminated by now. Patient falls unfortunately continue to be a challenge and occur within the hospital and nursing home settings at alarming and sometimes deadly rates. The Center for Disease Control estimates that 1,800 older adults living in nursing homes die each year from fall-related injuries. Survivors frequently sustain injuries resulting in permanent disability and reduced quality of life. Annually, a typical nursing home with 100 beds reports 100 to 200 falls and many falls go unreported (CDC, 2015). Falls occur more often in nursing homes because patients are generally weaker, have more chronic illnesses, have difficulty ambulating, memory issues,

The Centers for Medicare and Medicaid Services (CMS) has identified eight adverse conditions, and inpatient injurious falls continues to be the most common adverse condition (as cited in Tzeng, Hu & Yin, 2016). The inpatient falls in the “US hospitals range from 3.3 to 11.5 falls per 1,000 patient days” (as cited in Bouldin et al, 2013, p.13). Roughly 25% of patients are injured when they fall (Bouldin et al, 2013). Since 2005, the USA’s National Patient Safety Goal listed fall prevention as a goal (Bennett, Ockerby, Stinson, Willcocks, & Chalmers, 2014). Since 2008, hospitals no longer receive payments from CMS for health care cost connected to inpatient falls (Bouldin et al, 2013). CMS views inpatient injurious falls as injuries that should never occur (Bouldin et al., 2013). There is no doubt that quality improvement must continue to address inpatient injurious falls. Preventing falls and implementing interventions to lower the rates of falls is a major concern for hospitals and must be included in any quality improvement measure.

Burns, E.R., Stevens, JA. & Lee, R. (2016). The direct costs of fatal and non-fatal falls

social trends and medical advances have promoted significant changes in scientific research on the health of children in the United States. Injury remains a major contributor to childhood illness and death. However, among the causes of injuries, chronic diseases now account for the majority of days of hospitalization and death among children. Although mortality rates for all children has decreased significantly, social inequalities persist. About half the excess deaths in children of African Americans occurs in infancy, mainly due to preterm delivery, and the rest, mainly from the homicide and serious chronic diseases in. These challenges may require changes in practices and policies for the health of children today. The health of children in the United States poses a paradox that the mortality rate has decreased significantly.

Unintentional injuries are the leading cause of pediatric mortality, with preventable injuries killing more Canadian children than any other single disease (Parachute, 2016, Statistics Canada, 2012). Each year in Canada, preventable injuries cause 16,000 deaths, 60,000 disabilities, 3.5 million emergency room visits and most stingingly, one child dies every 9 hours as a result of an unintentional injury (Parachute, 2016). When examining infants specifically, research has identified that majority of unintentional injuries (90%) occur in and around the home, when infants are presumably being monitored by a responsible caregiver (National Safety Council,