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Murínová I, Kovačič M, Kelbich T. Do clinical pharmacists contribute to fall prevention in healthcare facilities also in the Czech Republic? 10 years of monitoring and experience from ÚVN Prague. Cas Lek Cesk 2022; 161:17-23. [PMID: 35354290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Clinical pharmacists are encouraged to participate in falls prevention programs in many healthcare facilities. A uniform methodology for the work of clinical pharmacist in fall prevention has not yet been established in the Czech Republic. The aim of this work is to offer the methodology based on our own data analysis. Retrospective clinical pharmacist's output analysis was performed in two areas: fall's pharmacoprevention and post-fall drug audits. In the results 78 % of patients who fell during hospitalization were over 65 years of age. Age was subsequently taken as the basic criterion for the patient's medication evaluation with regard to the risk of falling. Thanks to the widespread expansion of clinical pharmaceutical care and the newly introduced fall prevention and monitoring system at ÚVN Prague, there was a positive trend in the incidence of medication's adverse effects on patient's falls: in 2017 it was 34 % of cases, in 2020 only 13 %. Based on our data and experience, we offer a methodology for the clinical pharmacist's activity in fall prevention: 1. performing revision of medication also with regard to the risk of falls in patients over 65 years of age, 2. ensuring the automatic requests sending to the clinical pharmacy department in the case of a patient's fall in a medical facility.
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Kim YJ, Choi KO, Cho SH, Kim SJ. Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting. J Clin Nurs 2021; 31:3584-3594. [PMID: 34964175 DOI: 10.1111/jocn.16185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the measured fall risk score that more accurately reflects the changeable conditions in acute care settings, and to efficiently evaluate the association between falls and fall risk score. BACKGROUND The Morse Fall Scale (MFS) is a well-known easy-to-use tool, while the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) consists of items with high specificity. Evaluating suitable fall-risk assessment tools to measure these changeable conditions may contribute to preventing falls in acute care settings. DESIGN Retrospective case-control study using the STROBE checklist. METHODS In an acute care setting (708-bedded university hospital with a regional emergency medical centre), the non-fall group was adjusted to fall group using propensity score matching. According to the fall rate of 3-5%, non-fall groups for each tool were selected (1386 and 1947) from the before adjusted data, and the fall groups included 42 and 59. The applied covariates were individual characteristics that ordinarily changed such as age, gender, diagnostic department and hospitalisation period. The adjusted data were analysed using generalised estimating equations and mixed effect model. RESULTS After adjustment, the fall group measured using the JHFRAT had a significantly higher difference between the initial and re-measured total score than the non-fall group. The JHFRAT, especially with the re-measured score, had a higher AUC value for predicting falls than the MFS. MFS's sensitivity was 85.7%, and specificity was 58.8% at 50 points; for JHFRAT, these were 67.8% and 80.2% at 14 points, respectively. These cut-off points were used to evaluate validity during tool development and are commonly used as reference scores. CONCLUSIONS JHFRAT more accurately reflects acute changeable conditions related to fall risk measurements after admission. RELEVANCE TO CLINICAL PRACTICE JHFRAT may be useful for effective fall prevention activities in acute care settings.
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Affiliation(s)
- Young Ju Kim
- Department of Nursing, Uijenongbu St. Mary's Hospital, The Catholic University of Korea, Uijenongbu, Korea
| | - Kyoung-Ok Choi
- Department of Nursing, Uijenongbu St. Mary's Hospital, The Catholic University of Korea, Uijenongbu, Korea
| | - Suk Hyun Cho
- Review and Assessment Committee, Health Insurance Review & Assessment Service, Seoul, Korea
| | - Seok Jung Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Huang X, Yan J, Yang T, Yi Q, Shen Z, Yang G. Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:529-535. [PMID: 34148890 PMCID: PMC10930220 DOI: 10.11817/j.issn.1672-7347.2021.200332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients. METHODS A total of 59 358 hospitalized patients, who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale, served as a control, including 26 862 males and 32 496 females. While the 66 203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale, including 29 881 males and 36 322 females. The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups, and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing. The cost-effectiveness was analyzed. In addition, the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients. RESULTS The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100 000 and 3.82/100 000,respectively, there was no significant difference between the 2 groups (U=0.807, P>0.05); the injury rates of falls of Grade 2 and above in the observation group and the control group were 27.30% and 20.00%, respectively, with no significant difference (χ2=0.345, P>0.05); but the labor cost was increased by 130 641.82 Chinses Yuan, and the incremental cost-effectiveness ratio was 43 547.27. However, the incidence of fall was significant higher in the falling high-risk patients by the assessment of the Morse Fall Scale than that in the non-high-risk patients (U=2.941, P<0.05). CONCLUSIONS The evaluation of the Morse Fall Scale has a certain effect, but it is limited in the prevention of falls in adult hospitalized patients, and the cost-effectiveness analysis is not good. It is recommended to implement the intervention measures for high-risk patients after the assessment, which may improve the management level and efficiency of fall prevention.
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Affiliation(s)
- Xiaofang Huang
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Jin Yan
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Tubao Yang
- Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Qifeng Yi
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Zhiying Shen
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Guoli Yang
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
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Abstract
PURPOSE Construction and validation of a fall risk prediction model specific to inpatients receiving fall risk-increasing drugs (FRIDs) are described. METHODS In a retrospective cohort study of 75,036 admissions to 2 hospitals over a designated 22-month period that involved FRID exposure during the first 5 hospital days, factors influencing fall risk were investigated via logistic regression. The resultant risk prediction model was internally validated and its performance compared with that of a model based on Morse Fall Scale (MFS) scores. RESULTS A total of 220,904 patient-days of FRID exposure were evaluated. The three most commonly administered FRIDs were oxycodone (given on 79,697 patient-days, 36.08%), morphine (52,427, 23.73%) and hydromorphone (42,063, 19.04%). Within the 90th percentile of modeled risk scores, 144 of the 466 documented falls (30.9%) were captured by the developed risk prediction model (unbiased C statistic, 0.69), as compared with 94 falls (20.2%) captured using the MFS model (unbiased C statistic, 0.62). Strong predictors of inpatient falls included a history of falling (odds ratio [OR], 1.99; 95% confidence interval (CI), 1.42-2.80); overestimation of ability to ambulate (OR, 1.53; 95% CI, 1.12-2.09); and "comorbidity predisposition," a composite measure encompassing a history of falling and 11 past diagnoses (OR, 1.60; 95% CI, 1.30-1.97). CONCLUSION The proposed risk model for inpatient falls achieved superior predictive performance when compared with the MFS model. All risk factors were operationalized from discrete electronic health record fields, allowing full automation of real-time identification of high-risk patients.
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Affiliation(s)
- Yoonyoung Choi
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc., North Wales, PA
| | | | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Dandan Xu
- Division of Biostatistics, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Gloria Lipori
- UF Health and UF Health Sciences Center, Gainesville, FL
| | - Babette Brumback
- College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, and Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL
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Gringauz I, Shemesh Y, Dagan A, Israelov I, Feldman D, Pelz-Sinvani N, Justo D, Segal G. Risk of falling among hospitalized patients with high modified Morse scores could be further Stratified. BMC Health Serv Res 2017; 17:721. [PMID: 29132427 PMCID: PMC5684764 DOI: 10.1186/s12913-017-2685-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Falls during hospitalization harbor both clinical and financial outcomes. The modified Morse fall scale [MMFS] is widely used for an in-hospital risk-of-fall assessment. Nevertheless, the majority of patients at risk of falling, i.e. with high MMFS, do not fall. The aim of this study was to ascertain our study hypothesis that certain patients' characteristics (e.g. serum electrolytes, usage of a walking device etc.) could further stratify the risk of falls among hospitalized patients with MMFS. Methods This was a retrospective cohort analysis of adult patients hospitalized in Internal Medicine departments. Results The final cohort included 428 patients aged 76.8±14.0 years. All patients had high (9 or more) MMFS upon admission, and their mean MMFS was 16.2±6.1. A group of 139 (32.5%) patients who fell during their hospitalization was compared with a control group of 289 (67.5%) patients who did not fall. The fallers had higher MMFS, a higher prevalence of mild dependence, and a greater use of a cane or no walking device. Regression analysis showed the following patients' characteristics to be independently associated with an increased risk of falling: mild dependence (OR=3.99, 95% CI 1.97-8.08; p<0.0001), treatment by anti-epileptics (OR=3.9, 95% CI 1.36-11.18; p=0.011), treatment by hypoglycemic agents (OR=2.64, 95% CI 1.08-6.45; p= 0.033), and hypothyroidism (OR=3.66, 05%CI 1.62-8.30; p=0.002). In contrast to their role in the MMFS, the use of a walker or a wheelchair was found to decrease the risk of falling (OR=0.3, 95% CI 0.13-0.69; p=0.005 and OR=0.25, 95% CI 0.11-0.59; p= 0.002). Conclusions Further risk stratification of hospitalized patients, already known to have a high MMFS, which would take into account the characteristics pointed out in this study, should be attained.
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Affiliation(s)
- Irina Gringauz
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Shemesh
- Patient Safety Assurance Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Dagan
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irina Israelov
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Feldman
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Naama Pelz-Sinvani
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Justo
- Geriatric Medicine D Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Segal
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Dee V, Toro J, Lee S, Sherwood P, Haile D. Autologous Stem Cell Transplantation: The Predictive Value of the Morse Fall Scale in Hospitalized Patients
. Clin J Oncol Nurs 2017; 21:599-603. [PMID: 28945714 DOI: 10.1188/17.cjon.599-603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Falls are common in hospitalized patients undergoing autologous stem cell transplantation (ASCT). Research demonstrates that preventing patient falls requires knowledge of the risk factors and the circumstances preceding the patient's fall.
. OBJECTIVES To identify risk factors related to falls in recipients of ASCT and assess the predictive value of the Morse Fall Scale (MFS).
. METHODS Of the 288 patients who underwent transplantation during the study period, 14 were fallers. Twenty controls were randomly selected. The study used descriptive case-control analysis and simple logistic regression to analyze the data.
. FINDINGS Eight fallers and four non-fallers had high MFS scores. The logistic regression model indicated that patients with high MFS scores were 5.3 times more likely to fall and that for each day patients experienced diarrhea, their risk of fall increased 1.2 times.
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Affiliation(s)
| | - Juan Toro
- South Texas Veterans Health Care System
| | - Shuko Lee
- South Texas Veterans Health Care System
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Carazo M, Sadarangani T, Natarajan S, Katz SD, Blaum C, Dickson VV. Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure. West J Nurs Res 2016; 39:507-523. [PMID: 27531001 DOI: 10.1177/0193945916664077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.
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Affiliation(s)
- Matthew Carazo
- 1 New York University School of Medicine, New York City, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tina Sadarangani
- 3 New York University Rory Meyers College of Nursing, New York City, USA
| | - Sundar Natarajan
- 1 New York University School of Medicine, New York City, USA.,4 Veterans Affairs New York Harbor Healthcare System, New York City, USA
| | - Stuart D Katz
- 1 New York University School of Medicine, New York City, USA
| | - Caroline Blaum
- 1 New York University School of Medicine, New York City, USA
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Nassar N, Helou N, Madi C. Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon. J Clin Nurs 2013; 23:1620-9. [PMID: 24124974 DOI: 10.1111/jocn.12278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the predictive value of two instruments (the Morse Fall Scale (MFS) and the Heindrich II Fall Risk Model (HFRM)] in a Middle Eastern country (Lebanon) and to evaluate the factors that are related to falls. DESIGN A prospective observational cross-sectional design was used. BACKGROUND Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling. METHODS Data from 1815 inpatients at the American University of Beirut Medical Center (AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM. RESULTS The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling. CONCLUSIONS Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity. RELEVANCE TO CLINICAL PRACTICE It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient.
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Affiliation(s)
- Nada Nassar
- Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
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Baek S, Piao J, Jin Y, Lee SM. Validity of the Morse Fall Scale implemented in an electronic medical record system. J Clin Nurs 2013; 23:2434-40. [PMID: 24112535 DOI: 10.1111/jocn.12359] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the validity of the Morse Fall Scale by analysing the electronic medical records on fall risk during different phases of hospitalisation. BACKGROUND Regular monitoring on fall risk with a reliable and valid assessment tool is a key element in the fall prevention. In Korea, the Morse Fall Scale is currently being used in numerous medical institutions, yet it has not been comprehensively evaluated whether it is suitable and valid. DESIGN The study design was a retrospective case-control study. METHODS The participants included 151 fallers and 694 nonfallers. Data were extracted from a university hospital implementing Morse Fall Scale in the electronic medical records between October 2010 and June 2011. The nonfallers were selected by the stratified random sampling method among the patients who were in the hospital during the same period as the fallers. The Morse Fall Scale scores during three different time periods of hospital stay were used for analysis: the initial assessment score upon admission, the last and the maximum scores recorded from admission to the fall or discharge. RESULTS With the maximum Morse Fall Scale score and the best cut-off point of 51, validity indicators showed the highest performance: 0·72 for sensitivity, 0·91 for specificity, 0·63 for positive predictive value, 0·94 for negative predictive value, 0·63 for Youden Index and 0·77 for the area under the receiver operating characteristic curve. CONCLUSION The Morse Fall Scale showed relatively high predictive performance for the Korean population. RELEVANCE TO CLINICAL PRACTICE The study results recommend practice change in fall prevention. As the validity was highest when the patient was first classified into the high-risk group based on the Morse Fall Scale cut-off score 51, patients classified as high risk should be placed under special nursing interventions until the day of their discharge, regardless of change in the patient state.
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Affiliation(s)
- Seonhyeon Baek
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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