Development of an evidence-based fall risk assessment tool and evaluation of interrater reliability and nurses' perceptions of the tool's clarity and usability.

Abstract

To develop and test interrater reliability of an evidence-based fall risk assessment tool for nurses and to investigate how nurses perceived the clarity and usability of the tool. In phase 1, an evidence-based fall risk assessment tool was developed based on a literature review and expert discussion. The finalized tool assessed 11 risk factors and comprised 23 items. In phase 2, reliability testing was done. Two nurses out of a possible 125 participating nurses independently assessed each participating patient on admission with the assessment tool. The nurses then provided feedback on the clarity and usability of the tool. The interrater reliability was estimated by the percentage agreement, Cohen's kappa, and prevalence- and bias-adjusted kappa. Of the 164 patients who were recruited, 114 patients participated. After adjustment for prevalence and bias, only "frequent urination" and "night-time toileting" showed a less-than-substantial interrater agreement. Assessment of the items "cognitive impairment" and "night-time toileting" were most frequently reported to be problematic. The evidence-based fall risk assessment tool requires further modification and re-examination of interrater reliability is warranted. In particular, the cognitive impairment items need to be reconsidered in order to enable nurses to better assess patient cognition on the admission day.