Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

Leep Hunderfund, Andrea N.; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, Leann M.; Britton, Jeffrey W.
January 2011
Mayo Clinic Proceedings;Jan2011, Vol. 86 Issue 1, p19
Academic Journal
OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fail risk at admission would reduce inpatient fails on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either "Patient Is" or "Patient is not at high risk of fails by physician assessment" was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Pre implementation (January 1, 2006, to March 31, 2008) and post implementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of fails on other medical units did not significantly change (2.99 vs 3.33 fails per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments Individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction In inpatient falls.


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