Helen McDonald RN /niversit) of +ew 0ork Institute of Technolog) at /tica 1ome

Introduction
The purpose of this project is to evaluate two commonly used fall assessment tool in the hospital setting and decide which is more accurate at identifying patients at high risk for falls Falls are defined as a sudden and involuntary event, whether assisted or unassisted, whereby the patient descends to the ground or surface lower than original positioning. The Centers for Medicare and Medicaid Services define this as a never event!. Falls result in "#$ of all adverse events that take place in the hospital. Falls assessment tools are used to focus the strategy nurses use to identify high risk patients. They facilitate a means to complete an assessment in a timely and operative manner to identify multifactorial risks and implement fall prevention interventions. They assist to produce consistency were inter%rated reliability is poor due to nursing staff with varied e&perience levels and interpretations. Simplicity is achieved by using a small number of assessment items that produce reliable performance with evidenced%based scoring in target populations.

"valuation
Hendrich II Falls Tool
*onfusion or 2isorientation 2izziness or vertigo Impulsivit) #)mptomatic depression Altered elimination #e' (male 3rescribed anti4epileptics or benzodiazepines 5et /p and 5o Test 2eveloped and validated in an acute care inpatient setting but specific populations not specified 1ange 6478
High 1isk (95

Implementation
Morse Falls Scale
Histor) of falls #econdar) diagnosis Ambulator) aids I: Therap) 5ait "ental status :alidated in multiple care settings

Conclusion
The Hendrich II Falls Assessment Tool gives the best balance between sensitivit) and specificit)! *ompared to the "orse Falls #cale, it has the best reproducibilit), feasibilit) and validit)! +o falls assessment tool can completel) reduce falls! A falls assessment alone is not effective! +ursing education is needed to implement effective falls prevention interventions! ,I* need to assess and monitor for compliance with falls assessments on admission and at least ever) -.hrs as well as the implementation of falls prevention interventions to s)nchronize an effective falls prevention s)stem!

1ange 647-5
;ow risk (<-5 "edium risk (-5456 High risk (957

A small sample size of falls assessment documentation on the 5th floor was taken to determine compliance with the Hendrich II Falls Assessment Tool and hospital protocol for prevention implementation with patient identification markers (falls signs, socks and bracelets ! If possible, fall data records from when the "orse Fall #cale will be obtained and used and compare data since the Hendrich II Falls Assessment Tool has been implemented! Findings of the integrative review will be present to nursing staff during a staff meeting and$or unit managers during a %huddle& meeting! Teaching and reinforcement of the use of the falls assessment and protocols will be provided! #uggestions for improvement based on evidence will be made! Another small sample size of falls assessment documentation will be obtained in si' months to assess the effectiveness of intervention Discussion Cont! used in this pro(ect! Two4thirds of people who have fallen will fall again in the ne't 8 months Falls are an evolving problem @n admission= Ask the >uestion %Have )ou fallen within the last )ear!& *omplete a falls assessment within . hours, communicate the information to other nurses and disciplines

References
Ang, E., Mordiffi, S., & Wong, H. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal Of Advanced Nursing, 67(9), 1984-1992. doi:10.1111/j.1365-2648.2011.05646.x Aranda-Gallardo, M., Miguel, Canca-Sanchez, J., Mora-Banderas, A., & MoyaSuarez, A. (2013). Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review protocol. Journal Of Advanced Nursing, 69(1), 185-193. doi:10.1111/j.1365-2648.2012.06104.x Ask nurses for input when designing form: keep assessment tool simple, easy to incorporate. (2009). Hospice Management Advisor, 14(4), 39-40. CHAPMAN, J., BACHAND, D., & HYRKS, K. (2011). Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting. Journal Of Nursing Management, 19(1), 133 142. doi:10.1111/j.1365-2834.2010.01218.x Deshpande, N., Metter, E., Lauretani, F., Bandinelli, S., Guralnik, J., & Ferrucci, L. (2008). Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. Journal Of The American Geriatrics Society, 56(4), 615-620. doi:10.1111/j.1532-5415.2007.01639.x Heinze, C., Halfens, R., & Dassen, T. (2008). The reliability of the Hendrich Fall Risk Model in a geriatric hospital. International Journal Of Older People Nursing, 3(4), 252-257. Heinze, C., Halfens, R., Roll, S., & Dassen, T. (2006). Psychometric evaluation of the Hendrich Fall Risk Model. Journal Of Advanced Nursing, 53(3), 327-332. doi:10.1111/j.1365-2648.2006.03728.x Hood, L. & Leddy, S. (2006) Conceptual Bases of Professional Nursing. Philadelphia: Lippincott Williams& Wilkins Kim, E., Mordiffi, S., Bee, W., Devi, K., & Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal Of Advanced Nursing, 60(4), 427-435. doi:10.1111/j.1365 2648.2007.04419.x Lampiasi, N., & Jacobs, M. (2010). The role of physical and occupational therapies in fall prevention and management in the home setting. Care Management Journals, 11(2), 122-127. doi:10.1891/15210987.11.2.122 Myers, H. (2003). Hospital fall risk assessment tools: a critique of the literature. International Journal Of Nursing Practice, 9(4), 223-235. O'Connell, B., & Myers, H. (2002). Research in brief. The sensitivity and specificity of the Morse Fall Scale in an acute care setting. Journal Of Clinical Nursing, 11(1), 134-135. doi:10.1046/j.1365 2702.2002.00578.x Ohde, S., Terai, M., Oizumi, A., Takahashi, O., Deshpande, G., Takekata, M., & ... Fukui, T. (2012). The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical. BMC Health Services Research, 12197. doi:10.1186/1472-6963-12-197 Peri, K. (2007). Review: evidence from single studies shows that very few fall risk assessment tools can predict falls in elderly people. Evidence Based Nursing, 10(4), 123. Swartzell, K. L., Fulton, J. S., & Friesth, B. (2013). Relationship Between Occurrence of Falls and Fall-Risk Scores in an Acute Care Setting Using the Hendrich II Fall Risk Model. MEDSURG Nursing, 22(3), 180-187.

PICO Statement
'n the acute care inpatient setting, does the (endrich '' Falls )ssessment Tool produce accurate fall risk identification and reduce the fall rates compared to the Morse Fall Scale in a si& month period* Population% Fall +isk ,opulation- )cute care inpatients Intervention% (endrich '' Falls )ssessment Tool Comparison% Morse Fall Scale Outcome% .ecreased falls Time% / months
#ensitivit)= measures abilit) to correctl) identif) patients with high risk #pecificit)= measures abilit) to correctl) identif) patients with no risk :ariables= environment, population, inter4rater reliabilit), implementation of intervention, staff and patient compliance

+urse "anagers or ,ualit) improvement (,I focus groups should monitor compliance with fall assessment tool use, especiall) on admission and report feedback to nursing staff #taff education= functional use of the tool, appl)ing appropriate intervention plan based on results of the risk results found, review updated international studies and review fall cause anal)sis of recent hospital falls +urses should have a clear definition of what a fall is, polic) guidelines for interventions, and focus on the importance of falls reduction among the staff 1eviews show multifactorial interventions in hospital setting does reduce fall rates "ultifactorial interventions include= e'ercise, medication modification, vit 2 supplementation, environment and assistive technolog), staff and patient education %Ae had emplo)ees who didnBt complete an

Literature Revie Theory

'mogene 0ing1s System 'nteraction Model 2Theory of 3oal )ttainment4 uses mutually agreed upon goals, between the nurse and patient, to attain, maintain or restore health. 0ing says humans are working systems in an environment. The human perceives the environment as a whole person and interacts with t he environment. A review of the literature was completed through *I+AH; and "ed;ine using several search terms ! #ensitivit) and specificit) are significant factors to consider when choosing a tool to use, however, staff education and intervention strategies are e>uall) as important Tools should be adapted to the environment and population where the) are implemented 1outine use of unreliable scales provoke dangerous diversion of attention and resources to patients who are not at risk