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.

Morse Fall Scale Indicators 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

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

Marianjoy Fall Risk Assessment Altered elimination patterns 10 Unilateral neglect 10 Impaired cognition 20 Sensory deficits (hearing, sight, touch) 5 Agitation 20 Impaired mobility 5 History of previous falls 20 Impulsiveness 20 Communication deficits 20 Lower extremity hemiparesis 10 Activity intolerance 10 Episodes of dizziness/seizures 10 Special medications (narcotics, psychotropic, hypnotic, antidepressants etc.) 5 Diuretics, and drugs that increase GI motility 5 Upper extremity paresis 5 Age greater that 65 or less than 16 5 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

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Results – Descriptive Statistics

Results – Inferential Statistics

Results – Inferential Statistics

Results – Inferential Statistics Berg and FIM Significantly Differ, but Age does not significantly differ

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

Results from Crosstabulations

Sensitivity and Specificity 191 c 23 b 134 a 102 Fall + - Caution Club 236 ( a+b ) 214 c+d 125 a+c 325 b+d 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.

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Conclusions and Recommendations