Journal of Korean Academy of Nursing Administration (간호행정학회지)

Korean Academy of Nursing Administration (한국간호행정학회)
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Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls

낙상예방 활동의 지속적 질 관리 프로세스 확립을 위한 위험 사정도구 평가

  • 박인숙 (서울대학교병원 간호부) ;
  • 조인숙 (인하대학교 의과대학 간호학과) ;
  • 김은만 (선문대학교 간호학과) ;
  • 김민경 (인하대학교 의과대학 간호학과)
  • Received : 2011.09.11
  • Accepted : 2011.11.18
  • Published : 2011.12.30
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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.

Keywords

References

  1. American Medical Directors Association. (2002) Falls and fall risk. Columbia, MD: American Medical Directors Association.
  2. Atman, D. G. (1990). Practical statistics for medical research. London: Champman & Hall.
  3. Berwick, D. M. (1989). Continuous improvement as an ideal in health care. New England Journal of Medicine, 320(1), 53-56. https://doi.org/10.1056/NEJM198901053200110
  4. Brenner, H., & Gefeller, O. (1997). Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Statistics in Medicine, 16, 981-991. https://doi.org/10.1002/(SICI)1097-0258(19970515)16:9<981::AID-SIM510>3.0.CO;2-N
  5. Capezuti, E., Zwicker, D., Mezey, M., Fulmer, T. T., Gray-Miceli, D., & Kluger, M. (2008). Evidence-based geriatric nursing protocols for best practice (3rd ed.). New York: Springer Publishing Company.
  6. Chang, J. T., Morton. S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M.J., et al. (2004). Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomized controlled trials. British Medical Journal, 328(7441), 680. https://doi.org/10.1136/bmj.328.7441.680
  7. Gevirtz, F., & Nash, D. B. (2000). Enhancing physician performance through practice profiling. In Enhancing physician performance: advanced principles of medical management, edited by Ransom, S., Pinsky, W., Tropman, J., 91-116. Tampa, FL: American College of Physician Executives.
  8. Gray‐Miceli, D. (2008). Preventing falls in acute care. In E. Capezuti, D. Zwicker, M. Mezey, T. T. Fulmer, D. Gray-Miceli & M. Kluger (Eds.), Evidence‐based geriatric nursing protocols for best practice (3rd ed., pp. 161‐193). New York: Springer Publishing Company.
  9. Kim, C. G. & Seo, M. J. (2002). An analysis of fall incidence rate and its related factors of fall in hospital. Journal of Korean Society of Quality Assurance in Health Care, 9(2), 210-228.
  10. Kim, E., Lee, J. C., & Eom, M. R. (2008). Falls risk factors of inpatients. Journal of Korean Academy of Nursing, 38(5), 676-684. https://doi.org/10.4040/jkan.2008.38.5.676
  11. Kim, K. S., Kim, J. A., Kim, M. S., Kim, Y. J., Kim, E. S., Park, K. O., et al. (2009). Development of performance measures based on the nursing process for prevention and management of pressure ulcers, falls and pain. Journal of Korean Clinical Nursing Research, 15(1), 133-147.
  12. Laffel, G., & Blumenthal, D. (1989). The case for using industrial quality management science in health care organizations. Journal of the American Medical Association, 262(20), 2869-2873. https://doi.org/10.1001/jama.1989.03430200113036
  13. Milisen, K., Staelens, N., Schwendimann, R., De Paepe, L., Verhaeghe, J., Braes, T., et al. (2007). Fall prediction in inpatients by bedside nurses using the St. Thomas's risk assessment tool in falling elderly inpatients (STRATIFY) instrument: a multicenter Study. Journal Of The American Geriatrics Society, 55(5), 725-733. https://doi.org/10.1111/j.1532-5415.2007.01151.x
  14. Morse, J. M., & Morse, R. M. (1988) Calculating all rates: methodological concerns. Quality review bulletin, 14(12), 369-71.
  15. Nakai, A., Akeda, M., & Kawabata, I. (2006). Incidence and risk factors for inpatient falls in an academic acute‐care hospital. Journal of Nippon Medical School, 73(5), 265-270. https://doi.org/10.1272/jnms.73.265
  16. Oliver, D., Daly, F., Martin, F. C., & McMurdo, M. E. T. (2004). Risk factors and risk assessment tools for falls in hospital in‐patients: a systematic review. Age and Ageing, 33(2), 122-130. https://doi.org/10.1093/ageing/afh017
  17. O'conell, B., & Myers, H. (2002). Research in brief: the sensitivity and specificity of the morse fall scale in acute care setting. Journal of Clinical Nursing. 11(1), 134-135. https://doi.org/10.1046/j.1365-2702.2002.00578.x
  18. Park, I., Cho, I., & Kim, E. M. (2009). Comparison of fall rates from different resources: a self report system and an electronic medical record system. Paper presented at the 10th International Congress on Nursing Informatics, Helsinki, Finland.
  19. Perell, K. L., Nelson, A., Goldman, R., Luther, S. L., Prieto‐ Lewis, N., & Rubenstein, L. Z. (2001). Fall‐risk assessment measures: an analytic review Journal of Gerontology, 56(12), 761-766.
  20. Poses, R., Cebul, R., Collins, M., & Fager, S. (1986). The importance of disease prevalence in transporting clinical prediction rules: the case of streptococcal pharyngitis. Annals of Internal Medicine, 105(4), 586-591. https://doi.org/10.7326/0003-4819-105-4-586
  21. Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: what is will take to accelerate progress. Milbank Quarterly. 76(4), 593-624. https://doi.org/10.1111/1468-0009.00107
  22. Steinberg, D. (2009). Sample size for positive and negative predictive value in diagnostic research using case‐control designs. Biostatistics, 10(1), 94-105.
  23. Wyatt, J. C., & Altman, D. G. (1995). commentary: prognostic models: clinically useful or quickly forgotten? British Medical Journal, 311(7019), 1539-1541. https://doi.org/10.1136/bmj.311.7019.1539