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An Integrative Review of Pediatric Fall Risk Assessment Tools
Kimberly DiGerolamo1, Katherine Finn Davis1
1Department of Nursing, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104, USA.
Insights
Validated pediatric fall risk assessment tools (FRATs) are crucial for patient safety. However, existing tools lack reliability and validity across diverse pediatric populations, necessitating institutional validation and clinical judgment.
Area of Science:
- Pediatric Nursing
- Patient Safety
- Healthcare Quality Improvement
Background:
- Accurate patient fall risk assessment is essential for effective prevention strategies.
- Validated fall risk assessment tools (FRATs) aim to identify high-risk patients.
- Existing adult FRATs are often adapted for pediatric use but may not adequately assess pediatric-specific risk factors.
Purpose of the Study:
- To review and synthesize existing literature on fall risk assessment tools (FRATs) in the pediatric hospital setting.
- To evaluate the reliability and validity of current pediatric FRATs.
Main Methods:
- An integrative review of articles published between 2006 and 2015.
- Inclusion criteria: English language, pediatric populations (ages 0-21), and discussion of a FRAT.
- Synthesis of findings using the Johns Hopkins Nursing evidence appraisal system.
Main Results:
- Twelve relevant articles discussing pediatric fall prevention and FRATs were reviewed.
- Significant challenges exist in comparing FRATs due to variations in classifications, definitions, risk stratification, and inclusion criteria.
- No single pediatric FRAT demonstrated consistent reliability and validity across different institutions and patient populations.
Conclusions:
- Current pediatric FRATs lack universal reliability and validity.
- Institutions should select FRATs aligned with their specific patient population's risk factors.
- Validation of chosen FRATs within the institution and integration with nursing clinical judgment are critical for effective fall prevention.
Problem:
Patient fall prevention begins with accurate risk assessment. However, sustained improvements in prevention and quality of care include use of validated fall risk assessment tools (FRATs). The goal of FRATs is to identify patients at highest risk. Adult FRATs are often borrowed from to create tools for pediatric patients. Though factors associated with pediatric falls in the hospital setting are similar to those in adults, such as mobility, medication use, and cognitive impairment, adult FRATs and the factors associated with them do not adequately assess risk in children.
Eligibility Criteria:
Articles were limited to English language, ages 0-21years, and publish date 2006-2015.
Sample:
The search yielded 22 articles. Ten were excluded as the population was primarily adult or lacked discussion of a FRAT. Critical appraisal and findings were synthesized using the Johns Hopkins Nursing evidence appraisal system.
Results:
Twelve articles relevant to fall prevention in the pediatric hospital setting that discussed fall risk assessment and use of a FRAT were reviewed. Comparison between and accuracy of FRATs is challenged when different classifications, definitions, risk stratification, and inclusion criteria are used.
Conclusions:
Though there are several pediatric FRATs published in the literature, none have been found to be reliable and valid across institutions and diverse populations.
Implications:
This integrative review highlights the importance of choosing a FRAT based on an institution's identified risk factors and validating the tool for one's own patient population as well as using the tool in conjunction with nursing clinical judgment to guide interventions.
