Morse Fall Scale Research Articles

Residential cardiac rehabilitation (rCR) derived survival predictors in patients after transcatheter aortic valve replacement (TAVR): a retrospective multicenter study

Abstract Purpose To evaluate exercise-based rCR derived outcome predictors in patients referred after TAVR. Methods Data of 434 patients (aged 81±6 years) admitted to an average 3-week rCR program after TAVR (walking, up to 30 minutes of cycling or treadmill session twice daily, respiratory and calistenic training) from January 2009 to December 2017 and home discharged, were retrospectively collected at 10 Italian rCR Division of Istituti Clinici Maugeri SpA. Comorbidity (cumulative illness rated state-comorbidity index) (CIRS-CI) score, echocardiography on admission, Disability (Barthel Index) (BI) score, Morse Fall Scale score (MFS), six minutes walking test distance (6MWT) on admission and discharge and maximal training session intensity (MTSI expressed in METs per minutes) were collected. The mortality was assessed up to 3 years after rCR discharge. Results During a 3-years follow up there were 120 (28%) deaths. At t-test analysis non survivors compared to survivors had significantly higher CIRS CI (p=0.000), MFS score on admission (p=0.008) and discharge (p=0.017), serum creatinine level on admission (p=0.000) and discharge (p=0.000); moreover they had significantly lower BI score on admission (p=0.000) and discharge (P=0.000), left ventricle ejection fraction (p=0.008),6MWT on admission (p=0.001) and discharge (p=0.000) and MTSI (p=0.022) in comparison to survivors. At multivariate logistic stepwise analysis, BI score on admission and serum creatinine level at discharge were the only independent predictors of mortality (Table 1); the AUC of the final logistic model was 0.72. Conclusions Patients attending rCR after TAVR seem to be very old; overall mortality at 3 years follow up in patients discharged home after rCR is substantial. Disability profile on admission (measured by Barthel Index) and impaired renal function on discharge (measured by creatinine levels) are independently correlated to death at long term follow up. Funding Acknowledgement Type of funding source: None

Executive Functions Are Associated with Fall Risk but not Balance in Chronic Cerebrovascular Disease.

Background: Older people’s deficits in executive functions (EF) have been shown to lead to higher fall risk, postural sway, and reduced speed. Crucially, EF impairments are even more pronounced in individuals with chronic cerebrovascular disease (CVD), namely vascular cognitive impairment. Methods: In this retrospective cross-sectional study, we used a complete neuropsychological battery, including the Trail Making Test (TMT) and physical measures, such as the Morse fall and EQUI scales, to assess 66 individuals with chronic CVD. Linear regressions, Bayesian analyses, and model selection were performed to see the impact of EF, global cognition, and vascular parkinsonism/hemiplegia on physical measures (fall risk and balance). Results: The TMT part B and BA correlated (r = 0.44 and r = 0.45) with Morse fall scale. Only EF significantly explained fall risk, whereas global cognition and vascular parkinsonism/hemiplegia did not. These findings were confirmed by Bayesian evidence and parsimony model selection. Balance was not significantly correlated with any of the neuropsychological tests. Conclusions: This is the first study investigating the relationship between cognitive and physical measures in a sample of older people with chronic CVD. The results are consistent with previous findings that link EF with fall risk in CVD.

Prediction of fall events during admission using eXtreme gradient boosting: a comparative validation study

As the performance of current fall risk assessment tools is limited, clinicians face significant challenges in identifying patients at risk of falling. This study proposes an automatic fall risk prediction model based on eXtreme gradient boosting (XGB), using a data-driven approach to the standardized medical records. This study analyzed a cohort of 639 participants (297 fall patients and 342 controls) from Chang Gung Memorial Hospital, Chiayi Branch, Taiwan. A derivation cohort of 507 participants (257 fall patients and 250 controls) was collected for constructing the prediction model using the XGB algorithm. A comparative validation of XGB and the Morse Fall Scale (MFS) was conducted with a prospective cohort of 132 participants (40 fall patients and 92 controls). The areas under the curves (AUCs) of the receiver operating characteristic (ROC) curves were used to compare the prediction models. This machine learning method provided a higher sensitivity than the standard method for fall risk stratification. In addition, the most important predictors found (Department of Neuro-Rehabilitation, Department of Surgery, cardiovascular medication use, admission from the Emergency Department, and bed rest) provided new information on in-hospital fall event prediction and the identification of patients with a high fall risk.

Identification of important factors in an inpatient fall risk prediction model to improve the quality of care using EHR and electronic administrative data: A machine-learning approach

BackgroundInpatient falls, many resulting in injury or death, are a serious problem in hospital settings. Existing falls risk assessment tools, such as the Morse Fall Scale, give a risk score based on a set of factors, but don’t necessarily signal which factors are most important for predicting falls. Artificial intelligence (AI) methods provide an opportunity to improve predictive performance while also identifying the most important risk factors associated with hospital-acquired falls. We can glean insight into these risk factors by applying classification tree, bagging, random forest, and adaptive boosting methods applied to Electronic Health Record (EHR) data. ObjectiveThe purpose of this study was to use tree-based machine learning methods to determine the most important predictors of inpatient falls, while also validating each via cross-validation. Materials and methodsA case-control study was designed using EHR and electronic administrative data collected between January 1, 2013 to October 31, 2013 in 14 medical surgical units. The data contained 38 predictor variables which comprised of patient characteristics, admission information, assessment information, clinical data, and organizational characteristics. Classification tree, bagging, random forest, and adaptive boosting methods were used to identify the most important factors of inpatient fall-risk through variable importance measures. Sensitivity, specificity, and area under the ROC curve were computed via ten-fold cross validation and compared via pairwise t-tests. These methods were also compared to a univariate logistic regression of the Morse Fall Scale total score. ResultsIn terms of AUROC, bagging (0.89), random forest (0.90), and boosting (0.89) all outperformed the Morse Fall Scale (0.86) and the classification tree (0.85), but no differences were measured between bagging, random forest, and adaptive boosting, at a p-value of 0.05. History of Falls, Age, Morse Fall Scale total score, quality of gait, unit type, mental status, and number of high fall risk increasing drugs (FRIDs) were considered the most important features for predicting inpatient fall risk. ConclusionsMachine learning methods have the potential to identify the most relevant and novel factors for the detection of hospitalized patients at risk of falling, which would improve the quality of patient care, and to more fully support healthcare provider and organizational leadership decision-making. Nurses would be able to enhance their judgement to caring for patients at risk for falls. Our study may also serve as a reference for the development of AI-based prediction models of other iatrogenic conditions. To our knowledge, this is the first study to report the importance of patient, clinical, and organizational features based on the use of AI approaches.

Predicting Falls Using the Stroke Assessment of Fall Risk Tool.

Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke-specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. Prospective cohort study. Inpatient tertiary stroke rehabilitation unit. Patients (N = 220) with acute stroke. Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC-ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non-fallers using t-tests. Forty-eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non-fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi-neglect between fallers and non-fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC-ROC was 0.65 for SAFR and 0.56 for Morse. SAFR was significantly associated with fall risk and had better discrimination between fallers and non-fallers than Morse. The neurologic-specific hemi-neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed.

Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer.

AimLife expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer.MethodsData of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014–2016 were collected retrospectively. Patients were divided into study group (age 80–89 y), and control group (age 60–69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI).ResultsThe study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95–1.98, p=0.013).ConclusionDifferent screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial

ObjectivesTo evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults. DesignRandomized, single-blind, controlled trial. SettingA Spanish nursing home in the autonomous community of Extremadura, Spain. ParticipantsAn initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups. InterventionsBoth the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes. Main Outcome MeasuresTimed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS). ResultsAnalysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42). ConclusionsA proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

Preventing Falls Among Behavioral Health Patients.

Inpatient falls are among the most common hospital incidents reported. Fall-related injuries have significant implications for patients, staff, and organizations. Adult behavioral health inpatients are responsible for higher rates of injurious falls and challenge traditional fall prevention methods. An inpatient behavioral health unit in an acute care hospital identified an increased rate of injury from falls per 1,000 patient-days in three months; three falls resulted in major injury. The purpose of this quality improvement (QI) report is to describe the redesign of a fall prevention program for adult behavioral health inpatients using evidence-based practice (EBP) and QI methods. Root cause analyses (RCAs) were conducted on all three fall-related major injuries. Concurrently, a literature review identified EBP recommendations for fall prevention on behavioral health units. A fall prevention action program was developed consisting of four elements: RN education to improve Morse Fall Scale scoring, individualized fall prevention patient plans, revised staff workflow, and improved fall prevention communication. There were no fall-related injuries for six months and no fall-related major injuries for 12 months following implementation of the fall prevention program. Overall, this reduction in fall-related major injuries was sustained over a 21-month period. An interprofessional team approach using EBP and RCA is effective in redesigning and implementing a fall prevention program for the adult inpatient behavioral health population.

The Effects of Tandem Stance Therapy on the Risk of Falling in the Elderly

Abstract: Tandem Stance Therapy is a therapy that is usually given to the elderly who are at risk of falling. The purpose of this study was to analyze the effect of tandem stance therapy on the risk of falling in the elderly in Giri Emas Village, Sawan District, Buleleng Regency. The research design was pre-experimental with one group pretest post-test design approach with a sample of 64 respondents selected using simple random sampling technique. Data collection was performed using the Morse Fall Scale (MFS) questionnaire. This study uses the Wilcoxon test. The results showed that the pre-test means value was 2.41 and the post-test score was 2.27. Wilcoxon test results obtained pretest and posttest (0.003) &lt;α (0.05). It was concluded that there was an influence of Tandem Stance Therapy on Falling Risk in the Elderly in Giri Emas Village, Sawan District, Buleleng Regency.

Hodnocení rizika pádů

Rizikove faktory padů pacientů bývaji casto multifaktorialni. V ramci poskytovani bezpecne zdravotni pece je nutne tyto faktory vcas a spravně detekovat. V ceskem prostředi je doporuceno využivat jako nejefektivnějsi skaly Morse Fall Scale a The Conley Scale. Pro hodnoceni rizika padů u dětských pacientů neexistuje jednoznacný konsenzus.

Underweight in Men Had a Closer Relationship with Falls than Women in Centenarians.

The aim of the study was to assess the relationship between underweight and falls. It was a cross-sectional study in community-based participants from China Hainan Centenarian Cohort Study (CHCCS). A total of 942 centenarians (mean ages were 102.4 years in men and 102.9 years in women, 21.8% were semi-supercentenarians, and 3.2% were supercentenarians) were enrolled from July 2014 to December 2016. Height and weight were measured according to the standard protocol. Participants were interviewed face to face to self-report falls for recent 3 months. The risks of future falls were evaluated by Morse Fall Scale (MFS). The mean body mass index (BMI) was 19.04±2.79 kg/m2 in men and 18.07±3.27 kg/m2 in women. The 3-month incidences of once fall were 10.3% in men and 13.4% in women, recurrent falls were 15.4% in men and 13.4% in women, future high risks of falls were 36.6% in men and 44.3% in women. There were underweight by gender interactions on at least one fall (OR=1.39, 95% CI=1.04-1.86, P=0.026) and future high fall risk (OR=1.39, 95% CI=1.07-1.80, P=0.014). Men with underweight had higher ratios of at least one fall (OR=4.12, 95% CI=1.59-10.70, P=0.004), recurrent falls (OR=6.71, 95% CI=1.69-26.63, P=0.007) and high risk of future falls (OR=2.44, 95% CI=1.27-4.70, P=0.007), while women with underweight was only associated with high risk of future falls (OR=1.37, 95% CI=1.01-1.85, P=0.043). Compared with normal weight and overweight, underweight in men had a higher MFS Score (increased by average 7.6 points, P=0.010), yet this trend was not observed in women counterparts. Underweight was associated with incidences of 3-month and future high fall risk in centenarians, which was more pronounced in men. Underweight could be a marker in identifying potential falls in long-lived people, especially men, who need further measures to gaining weight to normal and preventing falling.

Postural Stability and Dynamic Balance in Adult Spinal Deformity: Prospective Pilot Study

We sought to evaluate dynamic balance and postural stability in patients with adult spinal deformity (ASD) compared with published age-matched normative data. Eleven patients with ASD were prospectively enrolled. Postural stability was tested using static and dynamic posturography; patients stood on a movable platform with an integrated force plate and performed standardized sensory organization testing (SOT), evaluating the influence of sensory processing on postural stability under 6 conditions, and motor control testing, assessing reflexive postural reactions to an external perturbation. Patient performance was compared with that of published age-matched controls. Quality of life metrics included scores on the Scoliosis Research Society-22 questionnaire, SF-36, and Morse Fall Scale. Correlations between postural stability and radiographic measurements were performed. ASD patients demonstrated significantly lower SOT scores (P ≤ 0.03) in 5 of 6 conditions tested and greater latency of limb movement during backward translation (P= 0.04) compared with controls. Lower SOT scores were associated with a history of falls. ASD patients who self-reported falling in the previous 6 months, when compared with nonfallers, demonstrated significantly lower SOT scores (P= 0.04) and significantly lower Scoliosis Research Society-22 self-image subscores (P= 0.003). Thoracic kyphosis and mediolateral sway (predictor of falls) were positively correlated in the eyes-open and eyes-closed conditions (P ≤ 0.04). ASD patients demonstrated impaired postural stability, diminished sensory integration, and delayed response to external perturbations compared with normal control data. Postural stability and quality of life metrics correlated with self-reported falls. These findings suggest that ASD patients have abnormal postural stability and may be at elevated risk of falls.

An analysis of fall incidence rate and risk factors in an inpatient rehabilitation unit: A retrospective study

ABSTRACT Background Accurate prediction of fall likelihood is advantageous for instituting fall prevention program in rehabilitation facilities. Objective This study was designed to determine the clinical measures, which can predict the risk of fall events in a rehabilitation hospital. Methods Medical records of 166 patients (114 males and 52 females) who were hospitalized in an adult inpatient unit of a rehabilitation hospital were retrospectively analyzed for this study. As predictor variables for assessing fall risk, demographic data and the following measurements were selectively collected from patient’s medical records: Tinetti Performance-Oriented Mobility Assessment-Ambulation (POMA-G), Timed Up and Go test (TUG), 10 m walk test, 2 min walk test, Korean version Mini-Mental State Examination (K-MMSE), Korean version of the Modified Barthel Index (KMBI), Berg Balance Scale (BBS), Global Deterioration Scale (GDS), and Morse Fall Scale (Morse FS). Results The Morse FS, TUG, and age were found to be risk factors for the classification of faller and non-faller groups. Conclusion This study suggests Morse FS, TUG, and age in the routine initial assessment upon admission in a rehabilitation setting, as key variables for screening the risk of fall. Additionally, the cutoff scores of Morse FS and TUG were observed to be more rigid than other clinical settings.

Using Functional Ability Measures to Assess Fall Risk in Acute Care.

Currently, it is not known whether integration of functional performance measures is sensitive and feasible for use in acute care settings. This cross-sectional study explored the subjective and objective measures of the risks of falling, falls efficacy, and functional abilities for inpatients in an adult acute care unit. The Morse Fall Scale (n = 30) and Timed Up and Go (TUG; n = 10) had excellent sensitivity (100%) for identifying participants with prior fall histories, while the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients only had good sensitivity (87.5%). Study findings suggest that implementation of feasible functional ability measures in conjunction with subjective fall risk measures could enhance accuracy and performance in identifying inpatient risks of falling in acute care settings.

Impact of Hearing Loss on Patient Falls in the Inpatient Setting

The objectives of this study were to investigate an association between the risk of patient falls and self-reported hearing loss and to examine whether self-reported hearing loss with versus without hearing aids predicts patient falls in an inpatient setting. This retrospective cohort analysis was conducted in 2018 in a large, urban, academic medical center. Participants included unique inpatients (N=52,805) of adults aged >18 years between February 1, 2017, and February 1, 2018. Outcome measures were falls in the inpatient setting and hearing loss with versus without hearing aids as predictors for patient falls. Self-reported hearing loss was associated with falls in the inpatient setting (OR=1.74, 95% CI=1.46, 2.07, p<1.43 × 10-9). Among patients with hearing impairment, a lack of hearing aids increased the risk for falls in the inpatient setting (OR=2.70, 95% CI=1.64, 4.69, p<1.41 × 10-5). After accounting for the risk of fall using the Morse Fall Scale (which does not include hearing impairment) and controlling for age and sex, patients with hearing loss and no hearing aids were significantly more likely to fall (OR=2.44, 95% CI=1.002, 5.654, p<0.042), but patients with hearing loss who did have hearing aids were not significantly more likely to fall (p<0.889). Hearing loss together with the Morse Fall Scale better predicted falls than the Morse Fall Scale alone (p<0.017). In the inpatient setting, there was a positive association between hearing loss and falls. However, among patients with hearing loss, only those without hearing aids were significantly more likely to fall, accounting for the Morse Fall Scale score and demographics characteristics. These findings support adding hearing loss as a modifiable risk factor in risk assessment tools for falls and exploring the use of amplification devices as an intervention.

Risk factors and functional outcomes of surgical treatment of fall-related hip fractures in patients with Parkinson’s disease

urpose: One of the cardinal symptoms of Parkinson’s disease (PD) is represented by postural instability and disturbed balance which can cause frequent falls in these patients. Indeed, the increased risk of falling in combination with osteoporosis puts PD patients at high risk for hip osteoporotic fractures. This study was aimed to evaluate the potential risk factors associated with fall-related hip fracture in individual with PD and 2) to determine the impact of the disease on the perioperative course and functional outcome of these fractures. Materials and methods: From 2005 to 2016, 209 patients (98 males and 111 females, aged &gt;65 years) with a definitive diagnosis of idiopathic parkinsonism were enrolled in this multicenter retrospective study. From these patients, 123 sustained falling, while 86 did not. From the patients who sustained a fall, 41 patients sustained a hip fracture and were surgically treated with either internal fixation or hip hemiarthroplasty. The recorded clinical features were age, disease duration, falls, and type fracture. The risk of fall was assessed by Morse fall scale. According to the scores of the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr staging(H&amp;Y) we graded the PD severity. Osteoporosis was diagnosed using bone mineral density (BMD). The pre-fracture Barthel Index (BI) and Timed Up and Go test (TUG) were used to assess the functional status. In order to compare parameters that determine the functional result, was included a reference group of 40, sex- and age-matched, patients. This group comprised of individuals without intake of anti-parkinson medication. The perioperative complications and the in-hospital mortality were both reported. Results: The mean follow-up was 24-months. In this study, the percentage of falls was 58.8%, while the percentage of osteoporosis between patients with and without falls were respectively 33.3% (42/123) and 15.4% (13/86). 74 patients had fall-related fractures. Statistical analysis of the clinical manifestations and functional score findings between the PD patients with fall-related fractures and PD patients without fracture, revealed that sex (p = 0.001), mean Morse fall scale (p &lt; 0.0001) and Hoehn and Yahr stage (p = 0.009) were significant variables. Regarding the functional outcome, no significant differences were observed between the groups [BI (p = 0.21) and TUG (p = 0.89)]. At the final follow-up, in patients with PD who were surgically treated for a fall-related hip fracture compare to patients without PD, the functional outcome was reduced according to Barthel Index (p = 0.001). Urinary tract infection was the more frequent perioperative complication. Post-operative pneumonia is another frequent complication, occurred in 5.5% of our series. 8 of 41 patients developed a pressure sore, while 1 patient with femoral neck fracture suffered a dislocation and underwent revision surgery. The mean length of hospital stay for Parkinson’s disease patients was 14 days, while patients without PD were staying 9 days.The in-hospital mortality rate for all patients was 4.3 %. Conclusions: Female sex, and advanced stage of PD and a higher mean Morse fall scale are associated with higher risk of fall-related hip fractures. Patients with PD who suffered a hip fracture are inclined to a longer hospital stay and a higher risk of complications. However, Parkinson’s disease does not represent a risk factor for a higher mortality or an inferior functional result, but in these patients, after 2-years follow-up, the functional outcome was reduced according to Barthel Index.

Predicting Falls Risk in Hospital; KPJ Seremban Experience

Introduction: Falls may result in injuries, prolonged hospitalization, increase in morbidity and mortality, incur cost to the individual and the healthcare system and increase potential litigation. Various hospital fall prevention programs such as Morse Fall Scale Assessment Tool have been implemented in the last decade; however most of the program had no sustained effects on falls reduction over extended period of time. Benchmarking from private hospitals showed patients fall increased by 27% in 2008 as compared to 2007 (MPC report, 2008). There were 25 cases of falls in 2008 at KPJ Seremban Specialist Hospital. The objective of this program is to comply with The Joint Commission’s National Patient Safety Goals 9, “reduce the risk of patient harm resulting from falls” and to formulate evidence based best clinical practice recommendations on assessment and prevention of falls in the hospital for all inpatients, outpatients, customers and staffs within hospital premises. Materials and Methods: Contributing factors were identified based on the retrospective analysis of falls from 1st.January 2008 to 30th September 2008. A fall risk assessment tool identified as KPJ FRAT (KPJ Fall Risk Assessment Tool) for inpatient was developed and various other strategies to reduce the risk of falls throughout the hospital premises were identified. Points of engagement for inpatient assessment using KPJ FRAT were on admission, transfer in or when there is a change in patients’ condition. A prospective descriptive study was done and data was collected from 1st January 2009 till 31st December 2009 through interview with patients, healthcare providers and review of adverse event reports and medical records. Results: No of inpatients during this study were 37058 and there were 13 falls. The post implementation data reflects for every 1000 inpatient days the fall rate decreased to 4.3 falls. Conclusion: The use of KPJ FRAT and Fall Prevention program implemented throughout KPJ SSH has reduced the incidence of falls significantly by 48%. This might be due to increase awareness among the staff, hospital wide policy to report all cases and the formation of patient safety committee to formulate policy and reinforce the implementation processes. Limitation of the study include under reporting and heavy workload.

Avaliação do risco de quedas em uma unidade de clínica de um hospital universitário

Objetivo: Avaliar o risco de quedas de pacientes em unidade de clínica médica de um hospital universitário. Método: Estudo documental, transversal, descritivo, realizado de maio a julho de 2018, em uma clínica médica de um hospital universitário do Rio de Janeiro que avaliou o risco de queda través da escala de Morse em pacientes com 18 anos ou mais. Utilizou-se a estatística descritiva simples para análise Resultados: Investigou-se 53prontuários. O maior percentual foi do sexo feminino (34 - 64%); idade entre 18 e 97; não possuíam histórico de quedas (35 – 66%); apresentavam diagnósticos secundários (48 – 90,6%); deambulavam sozinhos ou com auxílio ou estavam acamados (53 - 100%); faziam uso de terapia endovenosa (48 - 90,6%); possuíam marcha normal, não deambulavam, estavam acamados ou possuíam cadeira de rodas (32 - 60,4%) e encontravam-se orientados (45 -84,9%). Dezoito (33,9%) apresentaram queda nos últimos três meses anteriores à internação e quatro (7,6) sofreram queda durante o período coleta. A maioria dos pacientes, apresentaram alto risco no início e no final de sua internação. Conclusão: Este estudo demonstrou a importância de avaliação de risco para quedas, durante admissão na instituição hospitalar e periodicamente, com intuito de possibilitar estratégias de prevenção desse tipo de incidente.

Comparison of two fall-risk assessment tools used in a long-term care facility

PurposeThe purpose of this paper is to compare the ability of the Morse Fall Scale (MFS) and Farmer's fall-risk assessment tool (FFAT) to identify correlations between risk factors and falls among older adult long-term care (LTC) facility residents.Design/methodology/approachThis was a correlational retrospective study. 200 medical records of older adults hospitalized in a LTC facility in central Israel, from January 2017 to January 2018, were examined.FindingsOf all the residents, 75% and 99.5% of the residents were identified as having a high fall risk according to the MFS and FFAT, respectively. Only 12.5% of residents actually fell. MFS score was weakly correlated with actual falls (odds ratio = 1.035). It was also found that all fallers fell during their first week at the facility.Research limitations/implicationsFuture research should explore the ability of the tools to capture changes in the fall risk by repeat assessments, as this has not been examined in the present study.Practical implicationsThe MFS and FFAT tool may have little value in assessing fall risk in older adult LTC facility residents. Therefore, nurses should perform a clinical evaluation of each individual patient. In addition, nurses should place a particular emphasis on fall risk and prevention during the first week following admission.Originality/valueThe findings of the present study raise doubts regarding the utility of the common practice of assessing fall risk in older adult LTC facility residents using the tools MFS and the FFAT, thus emphasizing the need to adopt a different approach.

Making Fall Risk Assessment Clinically Relevant in an Adult Psychiatric Setting.

The purpose of this non-experimental descriptive study was to measure psychiatric clinical nurses' (N = 25) perceptions of the Edmonson Psychiatric Falls Risk Assessment Tool© (EPFRAT) compared to the Morse Fall Scale (MFS) and to evaluate patient falls with injury rates 12 months before and after the study. The setting was a 27-bed, adult psychiatric unit in a community-based teaching hospital located in the Northeast region of the United States. The EPFRAT and MFS were used to assess fall risk in 216 patients over 3 months. Findings indicated that the EPFRAT was more user-friendly and relevant; improved nurses' clinical judgment in identifying high-risk patients; and nurses were supportive toward changing practice from using the MFS to EPFRAT for fall risk assessment. Falls with injury rates decreased by 0.52 per 1,000 patient care days post-implementation of the EPFRAT. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 21-26.].