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.
This study found that the Auto-FallRAS results were better than were the nurses' predictions. The advantage of the Auto-FallRAS is that it automatically analyzes information and shows patients' fall risk assessment results without requiring additional time from nurses.
In this study, we evaluated the validity of the Braden scale in assessing the risk of pressure ulcers. Longitudinal clinical data including weekly Braden scale scores for 1,138 patients admitted to a university hospital who developed pressure ulcers during the hospital stay and 4,794 who did not develop pressure ulcers were extracted from the hospital's electronic medical record system. Braden scale scores at three points during hospitalization were analyzed: the initial score at admission, the last score recorded before diagnosis (for pressure ulcer patients) or before discharge (for those without pressure ulcers), and the minimum (highest-risk) score recorded. Using these data, the predictive validity of the scale was evaluated using a cut-off score of 18, followed by an evaluation of the relative advantages and disadvantages of cut-off scores from 12 to 19. Among patients in the general units, the minimum score had the greatest sensitivity (0.85), negative predictive value (NPV; 0.98), and Youden index (0.73). Among patients in the intensive care units, the last score had the best NPV (0.65), Youden index (0.53), and area under the receiver operating characteristic curve (0.78), while the minimum score had the highest sensitivity (0.88). The optimal cut-off score for patients in the general units was 19 and for those in the intensive care units was 18. These results support a higher cut-off score than previously recommended, particularly for severely ill patients who are more prone to developing pressure ulcers.
Among care providers, nurses have the most influence on the occurrence of delirium in patients. To identify and investigate the risk factors associated with delirium and analyse the nurse's influence on delirium, a secondary data analysis approach was used with clinical data from the electronic medical record and health care provider data from the management information systems of a university hospital. Data of 3284 patients (delirium = 688, non-delirium = 2596) hospitalized in the medical and surgical intensive care units containing 2178 variables were analysed. Donabedian's structure-process-outcome model was applied to categorize the factors for multilevel hierarchical logistic regression analysis. Sixteen factors (10 patient factors, 1 provider factor, 1 environmental factor, 2 nursing intervention factors and 2 medical intervention factors) were identified as significant in the final model. Longer intensive care unit experience of nurses did not decrease the risk of delirium. Greater number of nursing intervention needs and greater use of restraints were associated with an increased risk of delirium. The duration of nursing career did not affect the reduction of the risk of delirium. Nurses should therefore endeavour to acquire nursing experience specific for delirium care and attend training courses for delirium management.
This retrospective case-control study investigated risk factors for falls in hospitalized patients and the influence of falls on patient outcomes, using electronic medical records (EMRs) in a South Korean tertiary university hospital. Data were obtained from 868 patients who had experienced a fall and 3,472 patients who had not. Potential risk factors were obtained from EMR data and analyzed using hierarchical logistic regression analysis. Multiple logistic and linear regressions were used to analyze the influence of falls on patient outcomes. Results showed that introducing a fall prevention reinforcement policy contributed to reducing fall risk. Hospital inpatient falls contribute to negative patient outcomes (mortality, readmission, emergency room visits after discharge, length of stay, and costs).
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