Sunday, November 4, 2007

This presentation is part of : Leadership in Promoting Patient Safety
Preventing Patient Falls: The Challenges of Predicting Patients at Risk for Falling and Choosing a "Best Possible" Fall Risk Assessment Tool
Joanne Chapman, RN, BSN, MSN, MEd, R1, Maine Medical Center, Portland, ME, USA, Deborah Dolan, RN, BSN, CNA, BC, R-6, Maine Medical Center, Portland, ME, USA, and Kristiina Hyrkas, PhD, LicNSc, MNSc, RN, Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, ME, USA.
Learning Objective #1: identify a process to evaluate the effectiveness of the fall reduction program in accordance with National Patient Safety Goals
Learning Objective #2: describe the decision making process to chose the best possible fall assessment tool

BACKGROUND: Evaluating the effectiveness of fall prevention programs continues to be an area for improvement in health care. Developing and testing falls risk assessment tools is a challenge since prevention interventions are used for patients at risk.
Purpose: In the spring of 2006 the staff at Maine Medical Center asked the question “What is the best possible tool to predict and prevent patient falls.” The purpose of this study was to pilot test three (3) fall risk assessment tools: the Hendrich II fall risk scale; the New York Presbyterian/University Hospital of Columbia and Cornell assessment; and the Morse Fall Scale alongside the MMC tool in units where the reported fall rates were higher than 0.00.  The aim of the study was to test the reliability, sensitivity and specificity of the tools.
Method: In this study 34 RN’s completed all four assessments on a total of 1546 patients. The incident reporting system was cross referenced for all patients in the study to assess incidence of falls.
Findings: In determining the best tool for use at the hospital, sensitivity, specificity and reliability were important to consider.  The sensitivity was 57.1-100% and the specificity was 24.9 – 69.3%. Closer examination of the small sub-group of patients who fell showed that 57.9% of the patients had had the purple band and the fall risk sign at the door. A CNA was assigned for 54.4% of these patients and 41.1% had a physical therapy evaluation. Bed/chair alarms were in use for 49.1% of these patients.
Discussion: One tool clearly emerged as the best tool for the populations tested. Determining which tool to use and the manner in which to use it was guided by the research. Falls are a threat to patient safety and the sustained utilization of combination of falls prevention interventions is highly important