Marianjoy Rehabilitation Hospital Fall Risk Assessment Tool Project Donna Pilkington, RN, MSML, CRRN Kathleen Ruroede, PhD, MEd, RN Nancy Cutler, RN, MS, CRRN
Fall Risk Assessment Literature • Morse Fall Scale • Marianjoy Fall Risk Assessment
Morse Fall Scale • The Morse Fall Scale (MFS) is a rapid and simple method of assessing a patient’s 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.
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 Morse Fall Scale Indicators
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 > 51 High Risk Precautions
Altered elimination patterns10 Unilateral neglect 10 Impaired cognition 20 Sensory deficits (hearing, sight, touch)5 Agitation20 Impaired mobility5 History of previous falls20 Impulsiveness 20 Communication deficits20 Lower extremity hemiparesis10 Activity intolerance10 Episodes of dizziness/seizures 10 Special medications (narcotics, psychotropic, hypnotic, antidepressants etc.)5 Diuretics, and drugs that increase GI motility 5 Upper extremity paresis5 Age greater that 65 or less than 165 Marianjoy Fall Risk Assessment • High Risk: >60 points Place Patient in Caution Club
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?
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
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
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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
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
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
Replicated Study with a Larger Sample • Statistical Procedures • Validity procedures using factor analysis (component analysis) • Reliability analysis using Cronbach’s Alpha • Logistic regression to develop predictive model of fall status • Development of new “Caution Club” threshold value – New Threshold Cut Score = > 4
Results – Inferential Statistics Berg and FIM Significantly Differ, but Age does not significantlydiffer
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
Factor Analysis and Reliability • Three Components Extracted • 55% Total Explained Variance in Model
Logistic Regression Model • R Square Value .253
Fall Fall + + - - 236 236 a a a b b b ( ( a+b a+b ) ) + + 102 102 102 134 134 134 Caution Caution Club Club c c c d d d 214 214 - - ( ( c+d c+d ) ) 23 23 23 191 191 191 125 125 325 325 ( ( a+c a+c ) ) ( ( b+d b+d ) ) 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
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.
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.