In-hospital paediatric accidents: an integrative review of the literature.

Background: Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. Aim: To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Methods: Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Results: Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). Discussion: No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Conclusions: Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and rate calculation methods; the tools used to assess the risk of falls; and evidence-based practice aimed at preventing them. \ua9 2012 The Authors. International Nursing Review \ua9 2012 International Council of Nurses