Location

Virtual

Start Date

1-3-2024 8:00 AM

End Date

1-3-2024 3:30 PM

Keywords:

oregon

Description

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment Tool (MoBa), based on the literature and researcher expertise. MoBa consists of the factors altered mental status, impulsivity, gait, presenting complaints, and medications.

Purpose

The purposes of this IRB-approved research study were to evaluate sensitivity and specificity of three valid and reliable tools and the MoBa at predicting ED falls and to establish interrater reliability of MoBa.

Methods

A retrospective, random chart review was conducted to test whether the tools correctly predicted whether patients fell or not. Encounters for patients who fell in 2020 and 2019 at nine EDs (one went back to 2018 to obtain a minimum number of fall events), paired with a random sample of an equal number of adult patients who did not fall. The principal investigators applied the Morse, Memorial, Kinder, and MoBa to each of these encounters. Chi-square tests were completed to establish sensitivity and specificity.

To establish interrater reliability, nurse champions received education on MoBa. Champions identified 25 patients who consented to be assessed using MoBa, then two champions independently assessed the patient with the MoBa. The goal was to reach 80% agreement (same score) on each fall risk factor. Scripting was added to factors that did not initially reach 80% (history of falling and medications), and interrater reliability was completed again with 10 paired MoBa assessments per impacted ED, resulting in > 80% agreement on every factor.

Results

The retrospective review included 313 encounters; 15 met criteria for exclusion. The MoBa had sensitivity of 88.2% and specificity of 58.3%. The Kinder had sensitivity of 82% and specificity of 54.3%. The Memorial had sensitivity of 55.9% and specificity of 86.6%. The Morse had sensitivity of 78.9% and specificity of 53.5%. The determination was made to remove the factor “History of Falls” from the MoBa, per the initial study design, because

The percent agreement for interrater reliability per factor is as follows: altered mental status =94.29%, impulsivity =97.14%, gait =92.86%, presenting complaints =88.57%, and medications =84.29%.

Conclusion

The findings demonstrate that the MoBa has strong sensitivity and reasonable specificity and

is a reliable tool for adult ED patients.

Implications for Practice

Appropriate fall risk assessment can contribute to patient safety. The next step is to deploy the MoBa to understand the feasibility of the tool in practice.

Comments

Interested in learning more or using the MoBa ED Fall Risk Assessment Tool in your emergency department? Please email: roxanne.barra@providence.org

Department

Emergency Medicine

Department

Nursing

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Mar 1st, 8:00 AM Mar 1st, 3:30 PM

A Better Tool for ED Fall Risk Assessments: the Monego-Barra ED Fall Risk Assessment Tool (MoBa)

Virtual

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment Tool (MoBa), based on the literature and researcher expertise. MoBa consists of the factors altered mental status, impulsivity, gait, presenting complaints, and medications.

Purpose

The purposes of this IRB-approved research study were to evaluate sensitivity and specificity of three valid and reliable tools and the MoBa at predicting ED falls and to establish interrater reliability of MoBa.

Methods

A retrospective, random chart review was conducted to test whether the tools correctly predicted whether patients fell or not. Encounters for patients who fell in 2020 and 2019 at nine EDs (one went back to 2018 to obtain a minimum number of fall events), paired with a random sample of an equal number of adult patients who did not fall. The principal investigators applied the Morse, Memorial, Kinder, and MoBa to each of these encounters. Chi-square tests were completed to establish sensitivity and specificity.

To establish interrater reliability, nurse champions received education on MoBa. Champions identified 25 patients who consented to be assessed using MoBa, then two champions independently assessed the patient with the MoBa. The goal was to reach 80% agreement (same score) on each fall risk factor. Scripting was added to factors that did not initially reach 80% (history of falling and medications), and interrater reliability was completed again with 10 paired MoBa assessments per impacted ED, resulting in > 80% agreement on every factor.

Results

The retrospective review included 313 encounters; 15 met criteria for exclusion. The MoBa had sensitivity of 88.2% and specificity of 58.3%. The Kinder had sensitivity of 82% and specificity of 54.3%. The Memorial had sensitivity of 55.9% and specificity of 86.6%. The Morse had sensitivity of 78.9% and specificity of 53.5%. The determination was made to remove the factor “History of Falls” from the MoBa, per the initial study design, because

The percent agreement for interrater reliability per factor is as follows: altered mental status =94.29%, impulsivity =97.14%, gait =92.86%, presenting complaints =88.57%, and medications =84.29%.

Conclusion

The findings demonstrate that the MoBa has strong sensitivity and reasonable specificity and

is a reliable tool for adult ED patients.

Implications for Practice

Appropriate fall risk assessment can contribute to patient safety. The next step is to deploy the MoBa to understand the feasibility of the tool in practice.