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

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Fall Risk Assessment Literature

• Morse Fall Scale
• Marianjoy Fall Risk Assessment

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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.

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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
  

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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

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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

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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?

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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

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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
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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

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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

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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

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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
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Results Descriptive Statistics
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Results Inferential Statistics
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Results Inferential Statistics
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Results Inferential Statistics
Berg and FIM Significantly Differ, but Age does
not significantly differ
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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

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Factor Analysis and Reliability

• Three Components Extracted
• 55 Total Explained Variance in Model

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Logistic Regression Model

• R Square Value .253

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Results from Crosstabulations
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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.

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