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Fall Prevention Assessment Tools: Acute Care Setting

Helen McDonald RN SUNYIT November 3, 2013

History of Falls
A sudden and involuntary event, whether assisted or unassisted, whereby the patient (pt) descends to the ground or surface lower than original positioning Centers for Medicare and Medicaid Services define this as a never event Encompass 38% of all adverse events

Fall Assessment Tool Aims


Focus strategy; timely, operative, multifactorial identification with early implementation for prevention interventions Produce consistency; inter-rated reliability due to nursing staff with varied experience levels and interpretations Simplicity; small number of assessment items producing reliable performance with evidenced-based scoring in target population

PICO Statement
In the acute care inpatient setting, does the Hendrich II Falls Assessment Tool produce accurate fall risk identification and reduce the fall rates compared to the Morse Fall Scale in a six month period?
Population- Fall Risk Population; Acute care inpatients Intervention- Hendrich II Falls Assessment Tool Comparison- Morse Fall Scale Outcome- Decreased falls Time- 6 months

Assessment Tool Focus Comparison


Hendrich II Falls Assessment Tool

Confusion or Disorientation Dizziness or vertigo Impulsivity Symptomatic depression Altered elimination Sex (male) Prescribed anti-epileptics or benzodiazepines Get Up and Go Test

Morse Scale History of falls Secondary diagnosis Ambulatory aids IV Therapy Gait Mental status

Assessment Scoring
In both tools, each risk factor is assigned a score based on relative risk and summed to form a fall risk score.

Hendrich II Assessment Tool


Range 0-16
High Risk (>5)

Morse Scale
Range 0-125
Low risk (<25) Medium risk (25-50) High risk (>51)

Sensitivity and Specificity


Sensitivity
# of pts with high risk scores who fell divided by the total # of pts who fell Measures ability to correctly identify pts with high risk Low results decrease reliability when predicting high risk pts

Sensitivity and Specificity


Specificity
# of pts with low-risk scores who did not fall divided by the total # of pts who did not fall Measures ability to correctly identify pts with no risk High specificity insures focused resources to patients who are at high risk of falling

Study Conducted by Kim et al. (2007)


Population: Newly admitted medical, surgical, oncology, orthopedic and gynecology patients, 18 years of age or older. N= 140

Hendrich II 70.0 % Sensitivity 61.5 % Specificity Result Showed the best predictive validity, reproducibility and feasibility

Morse Scale ( 51) 55.0 % Sensitivity 91.2 % Specificity Result Risk factors are ambiguous resulting in diverse interpretation and inconsistency

Fall Rates
Reducing fall rates in the hospital setting is dependent on two factors:
The effectiveness of a falls assessment tool identifying high risk patients with limited false positives Implementing effective fall prevention intervention protocols

References
Ang, E., Mordiffi, S., & Wong, H. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal Of Advanced Nursing, 67(9), 1984-1992. doi:10.1111/j.1365-2648.2011.05646.x CHAPMAN, J., BACHAND, D., & HYRKS, K. (2011). Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting. Journal Of Nursing Management, 19(1), 133 142. doi:10.1111/j.1365-2834.2010.01218.x Heinze, C., Halfens, R., & Dassen, T. (2008). The reliability of the Hendrich Fall Risk Model in a geriatric hospital. International Journal Of Older People Nursing, 3(4), 252-257. Kim, E., Mordiffi, S., Bee, W., Devi, K., & Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal Of Advanced Nursing, 60(4), 427-435. doi:10.1111/j.1365 2648.2007.04419.x Myers, H. (2003). Hospital fall risk assessment tools: a critique of the literature. International Journal Of Nursing Practice, 9(4), 223-235. Swartzell, K. L., Fulton, J. S., & Friesth, B. (2013). Relationship Between Occurrence of Falls and Fall-Risk Scores in an Acute Care Setting Using the Hendrich II Fall Risk Model. MEDSURG Nursing, 22(3), 180-187.

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