Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients

Wen Hsuan Hou, Chun Mei Kang, Mu Hsing Ho, Jessie Ming Chuan Kuo, Hsiao Lien Chen, Wen Yin Chang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims and objectives: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design: Secondary data analysis. Methods: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

Original languageEnglish
Pages (from-to)698-706
JournalJournal of Clinical Nursing
Volume26
Issue number5-6
DOIs
Publication statusPublished - Mar 1 2017

Fingerprint

Inpatients
ROC Curve
Accidental Falls
Logistic Models
Nurses
Regression Analysis
Information Systems
Area Under Curve
Length of Stay
Teaching
Hospitalization
Nursing
Delivery of Health Care

Keywords

  • Falls
  • Inpatients
  • Predictive accuracy
  • Risk factors
  • Sensitivity
  • Specificity

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. / Hou, Wen Hsuan; Kang, Chun Mei; Ho, Mu Hsing; Kuo, Jessie Ming Chuan; Chen, Hsiao Lien; Chang, Wen Yin.

In: Journal of Clinical Nursing, Vol. 26, No. 5-6, 01.03.2017, p. 698-706.

Research output: Contribution to journalArticle

Hou, Wen Hsuan ; Kang, Chun Mei ; Ho, Mu Hsing ; Kuo, Jessie Ming Chuan ; Chen, Hsiao Lien ; Chang, Wen Yin. / Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. In: Journal of Clinical Nursing. 2017 ; Vol. 26, No. 5-6. pp. 698-706.
@article{a400d88c81d04330a2c4ecf351604e45,
title = "Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients",
abstract = "Aims and objectives: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design: Secondary data analysis. Methods: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60{\%}), satisfactory specificity (87{\%}), a positive predictive value of 2·0{\%} and a negative predictive value of 99{\%}. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8{\%}; specificity, 78{\%}). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.",
keywords = "Falls, Inpatients, Predictive accuracy, Risk factors, Sensitivity, Specificity",
author = "Hou, {Wen Hsuan} and Kang, {Chun Mei} and Ho, {Mu Hsing} and Kuo, {Jessie Ming Chuan} and Chen, {Hsiao Lien} and Chang, {Wen Yin}",
year = "2017",
month = "3",
day = "1",
doi = "10.1111/jocn.13510",
language = "English",
volume = "26",
pages = "698--706",
journal = "Journal of Clinical Nursing",
issn = "0962-1067",
publisher = "Wiley-Blackwell",
number = "5-6",

}

TY - JOUR

T1 - Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients

AU - Hou, Wen Hsuan

AU - Kang, Chun Mei

AU - Ho, Mu Hsing

AU - Kuo, Jessie Ming Chuan

AU - Chen, Hsiao Lien

AU - Chang, Wen Yin

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Aims and objectives: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design: Secondary data analysis. Methods: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

AB - Aims and objectives: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design: Secondary data analysis. Methods: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

KW - Falls

KW - Inpatients

KW - Predictive accuracy

KW - Risk factors

KW - Sensitivity

KW - Specificity

UR - http://www.scopus.com/inward/record.url?scp=85006320675&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006320675&partnerID=8YFLogxK

U2 - 10.1111/jocn.13510

DO - 10.1111/jocn.13510

M3 - Article

VL - 26

SP - 698

EP - 706

JO - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

IS - 5-6

ER -