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Original Article

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

Ihn Sook Park1, InSook Cho2, Eun Man Kim3, Min Kyung Kim4
Journal of Korean Academy of Nursing Administration 2011;17(4):484-492.
Published online: December 31, 2011

1Department of Nursing, Seoul National University, Korea.

2Associated professor, Department of Nursing, Inha University, Korea.

3Associate Professor, College of Nursing, SunMoon University, Korea.

4Graduate student, Department of Nursing, Inha University, Korea.

Correspondence: Cho, InSook. Department of Nursing, Inha University, 253, Yonghyeon-dong, Nam-gu, Incheon 402-751. Tel: 82-32-860-8201, Fax: 82-32-874-5880, insook.cho@inha.ac.kr
• Received: September 11, 2011   • Revised: October 24, 2011   • Accepted: November 18, 2011

Copyright © 2011 Korean Academy of Nursing Administration

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  • 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.
  • Key Words: Risk assessment; Predictive value of tests; Validation studies; Accidental falls; Hospitalization
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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)
jkana-17-484-g001.jpg
Figure 2
Fall CQI(c ontinuous quality improvement) process
jkana-17-484-g002.jpg
Table 1
Comparison of Patient Characteristics between the Faller and Non-Faller Groups
jkana-17-484-i001.jpg

†The Other category includes rehabilitation, gynecology, urology and internal medicine. ***p<.001

Table 2
Comparison of Items of the Fall Risk Assessment Tool between the Faller and Non Faller Groups
jkana-17-484-i002.jpg
Table 3
Confusion Matrix of the Fall Risk Assessment Tool
jkana-17-484-i003.jpg
Table 4
Results of the Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Odds Ratio and 95% Confidence Interval(CI) of the Fall Risk Assessment Tool
jkana-17-484-i004.jpg
Table 5
Results of the Logistic Regression Analysis of the Fall Risk Assessment Tool
jkana-17-484-i005.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Influence of the Patient Safety Culture and Nursing Work Environment on Fall Prevention Activities of Hospital Nurses
      Se-Young Jung, Eun-Young Kim
      Journal of Korean Academy of Nursing Administration.2022; 28(2): 78.     CrossRef
    • Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis
      Yeji Seo, Kyunghee Kim, Ji-Su Kim
      International Journal of Environmental Research and Public Health.2021; 18(8): 3963.     CrossRef
    • A risk-factor analysis of medical litigation judgments related to fall injuries in Korea
      Insook Kim, Seonae Won, Mijin Lee, Won Lee
      Medicine, Science and the Law.2018; 58(1): 16.     CrossRef
    • Automatic population of eMeasurements from EHR systems for inpatient falls
      Insook Cho, Eun-Hee Boo, Soo-Youn Lee, Patricia C Dykes
      Journal of the American Medical Informatics Association.2018; 25(6): 730.     CrossRef
    • Comparison of Content Coverage of Domestic and International Inpatient Falls Prevention Guidelines Using Standard Nursing Terminologies
      Insook Cho, Jihye Kim, Jisun Chae, Miran Jung, Yeon Hee Kim
      Korean Journal of Adult Nursing.2018; 30(6): 622.     CrossRef
    • Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients
      Eun-Ju Choi, Young-Shin Lee, Eun-Jung Yang, Ji-Hui Kim, Yeon-Hee Kim, Hyeoun-Ae Park
      Journal of Korean Academy of Nursing.2017; 47(3): 420.     CrossRef
    • The Affect Factors of Geriatric Hospital Nurse’s Falls Prevention Activities
      Ji-Young Jung, Gye Hyun Jung
      Journal of Health Informatics and Statistics.2016; 41(2): 203.     CrossRef
    • Validation of Fall Risk Assessment Scales among Hospitalized Patients in South Korea using Retrospective Data Analysis
      Young Ok Kang, Rhayun Song
      Korean Journal of Adult Nursing.2015; 27(1): 29.     CrossRef
    • Fall Risk Factors and Fall Risk Assessment of Inpatients
      Yoon Sook Kim, Smi Choi-Kwon
      Korean Journal of Adult Nursing.2013; 25(1): 74.     CrossRef
    • Predictive Effects of Previous Fall History on Accuracy of Fall Risk Assessment Tool in Acute Care Settings
      Ihn Sook Park
      Journal of Korean Academy of Fundamentals of Nursing.2012; 19(4): 444.     CrossRef

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    Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls
    J Korean Acad Nurs Adm. 2011;17(4):484-492.   Published online December 31, 2011
    DOI: https://doi.org/10.11111/jkana.2011.17.4.484
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    Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls
    J Korean Acad Nurs Adm. 2011;17(4):484-492.   Published online December 31, 2011
    DOI: https://doi.org/10.11111/jkana.2011.17.4.484
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    Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls
    Image Image
    Figure 1 ROC curve plotting sensitivity versus 1 specificity for each possible score of the fall risk assessment tool (AROC = 0.6017)
    Figure 2 Fall CQI(c ontinuous quality improvement) process

    Figure 1

    Figure 2

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

    Comparison of Patient Characteristics between the Faller and Non-Faller Groups

    †The Other category includes rehabilitation, gynecology, urology and internal medicine. ***p<.001

    Comparison of Items of the Fall Risk Assessment Tool between the Faller and Non Faller Groups

    Confusion Matrix of the Fall Risk Assessment Tool

    Results of the Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Odds Ratio and 95% Confidence Interval(CI) of the Fall Risk Assessment Tool

    Results of the Logistic Regression Analysis of the Fall Risk Assessment Tool
    Table 1 Comparison of Patient Characteristics between the Faller and Non-Faller Groups

    †The Other category includes rehabilitation, gynecology, urology and internal medicine. ***p<.001

    Table 2 Comparison of Items of the Fall Risk Assessment Tool between the Faller and Non Faller Groups

    Table 3 Confusion Matrix of the Fall Risk Assessment Tool

    Table 4 Results of the Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Odds Ratio and 95% Confidence Interval(CI) of the Fall Risk Assessment Tool

    Table 5 Results of the Logistic Regression Analysis of the Fall Risk Assessment Tool

    Table 1

    Table 2

    Table 3

    Table 4

    Table 5

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