Sensitivity and Specificity of Edmonson Psychiatric Fall Risk Assessment Tool in an Adult Inpatient Psychiatric Unit

Background: Falls are an important issue in hospitals as they can lead to increased lengths of stay, increased cost related to the stay, or increased chance of unplanned admission. The limited literature available about the fall risk for psychiatric patients indicates that they are at a higher risk of falling than medical patients due to unique risks of both their condition and the psychiatric in-patient environment (Allen, de Nesera & Robinson, 2012). Purpose: The goal of this project was to determine whether Edmonson, Robinson & Hughes’ (2011) Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) was more sensitive and specific than the Johns Hopkins Hospital Fall Risk Fall Assessment Tool when assessing psychiatric patients for risk for falls in a small community based hospital. Methods: In Phase I, a small sample of patient records were reviewed and EPFRAT was used to calculate fall risk score by the two authors to establish inter-rater reliability. In Phase 2, a retrospective chart review of all patients who had experienced a fall during their admission in 2012 was conducted and the EPFRAT score was calculated for the patient in the shift prior to the fall and compared with the Johns Hopkins Score for the same shift; a comparison group was established by matching patients who did not fall and who were similar in age and diagnosis. In Phase 3, staff nurses completed usual Johns Hopkins assessment in the electronic record, and the EPFRAT on paper. The scores were then compared. Staff response regarding ease of use was also considered. Results: Inter-rater reliability for EPFRAT was 83.3%. EPFRAT proved to be more sensitive and specific than the Johns Hopkins. EPFRAT identified twice as many patients who were at risk for falls that the Johns Hopkins during the pilot, and correctly identified 96% of people who did not fall as low-risk. Nurses who took part in the pilot evaluation deemed the EPFRAT to be user-friendly. Implications: Utilization of the EPFRAT fall assessment of behavioral inpatients each shift, when it follows appropriate training on completion of the tool and is combined with evidence-based fall prevention interventions, may help reduce the fall rate in the acute psychiatric in-patient setting.