J Korean Acad Nurs Adm.  2011 Dec;17(4):484-492.

Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls

• Park IS
• Cho I
• Kim EM
• Kim MK

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.

Keyword

Risk assessment; Predictive value of tests; Validation studies; Accidental falls; Hospitalization

MeSH Terms

Accidental Falls
Case-Control Studies
Cohort Studies
Gait
Hospitalization
Humans
Length of Stay
Logistic Models
Organothiophosphorus Compounds
Predictive Value of Tests
Quality Improvement
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Organothiophosphorus Compounds

Figure

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  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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