Query: morse fall scale patient prediction

title: Development of a scale to identify the fall prone patient
abstract: Patient falls are a serious problem, contributing to the morbidity and mortality of the elderly patient. This study reports on the development of the Morse Fall Scale. The scale consists of six scored items and discriminant analysis correctly classifies 80.5% of the patients. Validation of the scale by computer modeling was conducted. Data were randomly split and that analysis procedure repeated. Variables were obtained and weighted using half of these data, and these weights were tested on the remaining data. Similar results were obtained. Sensitivity of the scale was 78% and the positive predictive value, 10.3% Conversely, specificity was 83% and the negative predictive value, 99.3% Interrater reliability scores were r=.96. A prospective study in three clinical areas showed that the scale is sensitive to different patient conditions and to length of stay. Thus, the scale permits identification of the patient at risk of falling so that prevention strategies may be targeted to those individuals.

title: A prospective study to identify the fall prone patient.
abstract: A prospective study in 16 patient care units in two institutions was conducted to assess patients' risk of falling. Three types of patient care units were utilized (acute medical and surgical, long term geriatric and rehabilitation areas) with 2689 patients over a 4 month period rated daily for fall risk using the Morse Fall Scale. Differences in mean fall score were evident between the acute care areas and the long term and the rehabilitation areas. Examination of the scores in the acute care institution by length of stay, showed different patterns of fall risk; the mean score of the long term patients showed less variation and higher scores. Patients' falls were analyzed by fall score and type of fall. All types of falls (anticipated physiological, unanticipated physiological and accidental) and the severity of injuries increased, with increasing scores indicating clinical validity of the scale.

title: Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital.
abstract: Accidental patient falls are becoming a major cause of concern for hospitalized inpatients. It is well known that patients who fall once during their hospital stay are more likely to fall again and that fall rates tend to be higher in hospitalized elderly individuals. Concerned health care team personnel recognize that many accidental patient falls may be predicted and, thus, prevented. The best tool to predict falls has not been determined yet. The purpose of this study was to compare the abilities of the Morse Fall Scale (MFS) the Functional Reach (FR) test, and the nurses' clinical judgment in predicting those inpatients on a rehabilitation unit and a geriatric medical ward who were most likely to fall. A total of 98 patients were screened in a 3 month period, with each patient undergoing all three instruments the same day. The results showed that the two objective standardized tests (i.e. MFS, FR) were time consuming and often inconvenient and were no better at prediction than the clinical judgments made by the primary nurses.

title: Evaluation of the Morse Fall Scale in hospitalised patients.
abstract: Sir Several risk factors associated with falls in hospitalised patients have been identified [1, 2] Although a substantial number of assessment instruments for identifying hospitalised patients at risk of falling exists [3] their generalisability is limited [4] because only a few [2, 5] have been tested in settings other than those in which they were originally developed. The Morse Fall Scale (MFS) has been evaluated in different hospital settings [6 9] and has been used in a variety of patient populations [10 16] In search of an appropriate tool to identify admitting patients for risk of falling, the MFS appears to be most elaborate in view of its extensive development and testing in different hospital populations compared with others [3, 4] Its easy application in clinical practice supported this choice. However, no investigation to date has reported results of different cut off scores of the scale. This study aimed to evaluate the diagnostic value of different MFS cut offs to determine which score would be most useful in identifying in hospital patients at risk of falls.

title: Preventing patient falls establishing a fall intervention program
abstract: A highly updated and revised edition, this book combines a practical, how to approach with a research context. It also describes the process for developing and maintaining a fall prevention program in such institutions and outlines the highly acclaimed Morse Fall Scale, which has been adopted by the VA Hospital System and many more hospitals around the U.S.It includes a discussion of the process of implementing a fall prevention program in an institution using the Morse Fall Scale. It offers information for understanding how the scale works, and for evaluating the incidence, frequency, and severity of falls with rates of prevention. It features a revised appendix and new research section.

title: The safety of safety research: the case of patient fall research.
abstract: Most fall intervention programs consist of 2 components: fall risk prediction instruments to identify the patient who is likely to fall, and fall intervention strategies to prevent the patient from falling or to protect the patient from injury should a fall occur. While critical to the effectiveness of a fall intervention program, many of the fall risk prediction instruments have been criticized for their failure to accurately identify the fall prone patient. In this article, in the context of the validity assessments conducted on the Morse Fall Scale, the research conducted in the past 2 decades on fall risk assessment is critiqued. Some fall prediction research is based upon invalid assumptions and/or errors in design, both in the development of risk scales and in the evaluation of these instruments. Many of these instruments have been constructed with inappropriate reliance on face validity, have been evaluated inadequately, or have been tested in the clinical setting using an invalid design. Finally, improper use of fall scales in the clinical area may increase the risk of injury to the patient. The author concludes that much nursing research on patient falls does not contribute to improved patient safety.

title: Evaluation of the Morse Fall Scale: applicability in Chinese hospital populations.
abstract: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population.  To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter rater and test retest reliability.  The study was a cross sectional study.  The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study.  A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years.  The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls.  The scale had a sensitivity of 31% and a specificity of 83% when the cut off point was determined at 45. The field test demonstrated excellent inter rater reliability with an ICC value of 0.97 (95%CI 0.94 0.98) Repeatability was high with an ICC of 0.98 (95% CI 0.98 0.99) The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item to scale correlation.  The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.

title: Computerized evaluation of a scale to identify the fall prone patient.

title: Validity of the Morse Fall Scale implemented in an electronic medical record system.
abstract: To examine the validity of the Morse Fall Scale by analysing the electronic medical records on fall risk during different phases of hospitalisation.  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.  The study design was a retrospective case control study.  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.  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.  The Morse Fall Scale showed relatively high predictive performance for the Korean population.  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.

title: Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon.
abstract: 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.  A prospective observational cross sectional design was used.  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.  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.  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.  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.  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.