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Marianjoy Rehabilitation Hospital Fall Risk Assessment Tool Project

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Title: Marianjoy Rehabilitation Hospital Fall Risk Assessment Tool Project


1
Marianjoy Rehabilitation Hospital Fall Risk
Assessment Tool Project
  • Donna Pilkington, RN, MSML, CRRN
  • Kathleen Ruroede, PhD, MEd, RN
  • Nancy Cutler, RN, MS, CRRN

2
Fall Risk Assessment Literature
  • Morse Fall Scale
  • Marianjoy Fall Risk Assessment

3
Morse Fall Scale
  • The Morse Fall Scale (MFS) is a rapid and simple
    method of assessing a patients likelihood of
    falling.
  • The MFS is used widely in acute care settings,
    both in the hospital and long term care inpatient
    settings.
  • It consists of six variables that are quick and
    easy to score, and it has been shown to have
    predictive validity and interrater reliability.
  • A large majority of nurses (82.9) rate the scale
    as quick and easy to use, and
  • 54 estimated that it took less than 3 minutes to
    rate a patient.

4
Morse Fall Scale Indicators
  • 1. History of falling with in three months
  • No 0
    Yes 25
  • 2. Secondary Diagnosis
    No 0
    Yes 15
  • 3. Ambulatory Aid
  • Bed rest/nurse assist 0
  • Crutches/cane/walker 15
  • Furniture 30
  • IV/Heparin Lock
    No 0

    Yes 20
  • 5. Gait/Transferring
  • Normal/bedrest/immobile 0
  • Weak 10
  • Impaired 20
  • 6. Mental Status
  • Oriented to own ability 0
  • Forgets limitations 15

5
Scoring the Morse Fall Scale
  • Risk Level MFS score Action
  • ________________________________________
  • No Risk 0 24
    Basic Care
  • Low Risk 25 50
    Standard
    Fall Precautions
  • High Risk gt 51
    High Risk
  • Precautions

6
Marianjoy Fall Risk Assessment
  • Altered elimination patterns 10
  • Unilateral neglect 10
  • Impaired cognition 20
  • Sensory deficits (hearing,
  • sight, touch)
    5
  • Agitation 20
  • Impaired mobility 5
  • History of previous falls 20
  • Impulsiveness 20
  • Communication deficits 20
  • Lower extremity hemiparesis 10
  • Activity intolerance 10
  • Episodes of dizziness/seizures 10
  • Special medications (narcotics, psychotropic,
    hypnotic, antidepressants etc.)
    5
  • Diuretics, and drugs that
  • increase GI motility
    5
  • Upper extremity paresis 5
  • Age greater that 65 or less
  • than 16
    5
  • High Risk gt60 points Place Patient in
    Caution Club

7
Guiding Question?
  • Is the Marianjoy Fall Risk Assessment a valid
    and reliable method for predicting rehabilitation
    patient fall events if it is properly scored at
    admission?

8
Description of Research Study
  • Pilot study of 50 patients
  • 25 patients who had fallen
  • 25 matched patients who had not fallen
  • Dependent variable fall status
  • Independent variables
  • Caution Club status
  • Admission FIM total score
  • Modified admission Berg Balance total score
  • Admission fall risk assessment

9
Pilot Study Results
  • Patients significantly differed on Berg, FIM, and
    fall risk assessment scale
  • Five items found to separate fall groups
  • History of falls
  • Unilateral neglect
  • Episodes of dizziness / seizures
  • Special medications
  • Diuretics and drugs that increase GI motility
  • Sensory deficits

10
Always be alert for a new and creative idea...
You never know whats in your grasp
11
Replicated Study with a Larger Sample
  • 2005 data used
  • Total N 450 patients included
  • 125 patients with documented fall status
  • 325 patients who had not fallen were randomly
    selected from dataset
  • 232 patients were on caution club status
  • 218 patients not on caution club status

12
Replicated Study with a Larger Sample
  • Hypotheses tested
  • Patients did not significantly differ on fall
    status for
  • Fall assessment
  • Admission FIM Score
  • Modified Berg Balance Score
  • Age

13
Replicated Study with a Larger Sample
  • Statistical Procedures
  • Descriptive statistics
  • Sensitivity and specificity on original scale
  • Sensitivity and specificity on converted
    dichotomous scale
  • Item analysis on dichotomous scale that separate
    fallers from non-fallers
  • Total of 9 items discriminate groups

14
Replicated Study with a Larger Sample
  • Statistical Procedures
  • Validity procedures using factor analysis
    (component analysis)
  • Reliability analysis using Cronbachs Alpha
  • Logistic regression to develop predictive model
    of fall status
  • Development of new Caution Club threshold value
    New Threshold Cut Score gt 4

15
Always be ready for any surprises while working
on the project
16
Results Descriptive Statistics
17
Results Inferential Statistics
18
Results Inferential Statistics
19
Results Inferential Statistics
Berg and FIM Significantly Differ, but Age does
not significantly differ
20
Results from Item Analysis
  • Nine items found to discriminate fall groups
  • History of Falls (Weight 2)
  • Impulsiveness (Weight 2)
  • Communication Deficits
  • Altered Elimination Patterns
  • Unilateral Neglect
  • Lower Extremity Hemiparesis
  • Upper Extremity Hemiparesis
  • Special Medications
  • Diuretics and Drugs that Increase GI Mobility

21
Factor Analysis and Reliability
  • Three Components Extracted
  • 55 Total Explained Variance in Model

22
Logistic Regression Model
  • R Square Value .253

23
Results from Crosstabulations
24
Sensitivity and Specificity
Sensitivity a / (a c) 102 / 125 .82
Specificity d / (b d) 191 / 325 .59 False
Negative c / (a c) 23 / 125 .18 False
Positive b / (b d) 134 / 325 .41 PPV
a / (a b) 102 / 236 .43 NPV d / (c d)
191 / 214 .89
25
Odds and Odds Ratio
  • True Odds Ratio 6.25
  • This can be interpreted to mean that a patient
    who is on caution club status was 6.2 times more
    likely to incur a fall than a patient who was not
    on caution club status.

26
Odds and Odds Ratio
  • Relative Risk of a Fall 3.9
  • This can be interpreted to mean that the risk of
    patients on caution club status are 3.9 times
    more likely to occur than those patients who were
    not on caution club status.

27
Don't get off strategy and stay focused
28
Conclusions and Recommendations
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