Journal List > J Korean Acad Nurs Adm > v.17(4) > 1051614

Park, Cho, Kim, and Kim: Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls

Abstract

Purpose

The aims of study were; (1) to evaluate the validity and sensitivity of a fall-risk assessment tool, and (2) to establish continuous quality improvement (CQI) methods to monitor the effective use of the risk assessment tool.

Methods

A retrospective case-control cohort design was used. Analysis was conducted for 90 admissions as cases and 3,716 as controls during the 2006 and 2007 calendar years was conducted. Fallers were identified from the hospital's Accident Reporting System, and non-fallers were selected by randomized selection. Accuracy estimates, sensitivity analysis and logistic regression were used.

Results

At the lower cutoff score of one, sensitivity, specificity, and positive and negative predictive values were 82.2%, 19.3%, 0.03%, and 96.9%, respectively. The area under the ROC was 0.60 implying poor prediction. Logistic regression analysis showed that five out of nine constitutional items; age, history of falls, gait problems, and confusion were significantly associated with falls. Based on these results, we suggested a tailored falls CQI process with specific indexes.

Conclusion

The fall-risk assessment tool was found to need considerable reviews for its validity and usage problems in practice. It is also necessary to develop protocols for use and identify strategies that reflect changes in patient conditions during hospital stay.

Figures and Tables

Figure 1
ROC curve plotting sensitivity versus 1 specificity for each possible score of the fall risk assessment tool (AROC = 0.6017)
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Figure 2
Fall CQI(c ontinuous quality improvement) process
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Table 1
Comparison of Patient Characteristics between the Faller and Non-Faller Groups
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The Other category includes rehabilitation, gynecology, urology and internal medicine. ***p<.001

Table 2
Comparison of Items of the Fall Risk Assessment Tool between the Faller and Non Faller Groups
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Table 3
Confusion Matrix of the Fall Risk Assessment Tool
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Table 4
Results of the Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Odds Ratio and 95% Confidence Interval(CI) of the Fall Risk Assessment Tool
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Table 5
Results of the Logistic Regression Analysis of the Fall Risk Assessment Tool
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