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Nicklaus Children's Hospital

Nicklaus Children’s Hospital’s evidence-based falls prevention program keeps thousands of children safer around the world

Humpty Dumpty sat on a wall, but Humpty Dumpty did not have a great fall, if he was admitted to Nicklaus Children’s Hospital.

Nicklaus Children’s, part of Miami Children's Health System, reduced its falls rate by 41% with the help of its cleverly titled and globally acclaimed Humpty Dumpty Falls Prevention Program™.

Both the Joint Commission and the Institute of Medicine identifies inpatient falls as a significant patient safety risk, and have required organizations to have a fall reduction program with interventions in place.

Children’s growth and development, coupled with natural curiosity, makes them exceptionally prone to falls during a hospital stay, but at the time many published falls protocols were geared towards the adult population. In response to this void in pediatric safety, Nicklaus Children’s began developing the first program of its kind to specifically address the unique falls prevention needs of children.

In 2006, the hospital gathered all ancillary departments, including physical therapists, nutritionists, to develop age-appropriate parameters for its young patients. This evidence-based initiative enhanced the overall safety culture at Nicklaus Children’s and enabled nurses to demonstrate positive outcomes.

Since the hospital started work on the program, falls rates have steadily dropped by 41%, including a decrease in severity and injury from falls. Nicklaus Children’s had the lowest overall fall rate of 0.62, well below the mean of 1.24 established by the Texas Children’s Falls Collaborative in 2014.

In addition, the program earned Nicklaus Children’s the American Nurses Credentialing Center (ANCC) 2015 Magnet Prize®, an award that highlights innovative nursing practices.

“We are hoping after winning our Magnet Prize at the ANCC Magnet Conference, we will continue to spread the wealth of this program and impact the pediatric patients that we serve,” noted Laura Hernandez, MSN, ARNP, FNP-BC, CPN, Nurse Practitioner and Pediatric Educator at Nicklaus Children’s.

Currently, more than 1,150 hospitals nationally and internationally are using the Humpty Dumpty Falls Assessment scale and tools. The program has been translated into five languages and is in use in 18 countries in six continents.

The program works by pulling pertinent patient information from Cerner Millennium®. A fall assessment embedded into Cerner’s nursing documentation prompts nurses to evaluate patients once per shift, twice a day to ensure continual vigilance.

Key factors captured in the EHR used to assess a patient’s fall risk include, age, diagnosis, cognitive impairments, medication usage and operating room (OR) or surgery transfers. Based on this data, the program numerically scores each patient’s fall risk on a scale from 1-23; any patient with a score of 12 or over is high-risk.

Once a patient is identified as high-risk, additional nursing tasks are deployed to prevent an accidental fall, such as raising guard rails, adding bedside commodes and providing extra education to patients and their family members that will be present during the stay.

A child goes to the hospital to get out of pain, not into it. The ground-breaking falls prevention work at Nicklaus Children’s helps children around the world – thanks to nurses, a nursery rhyme, and an EHR.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.