Fall prevention: is the STRATIFY tool the right instrument in Italian Hospital inpatient? A retrospective observational study

Abstract

BackgroundAlthough several risk assessment tools are in use, uncertainties on their accuracy in detecting fall risk already exist. Choosing the most accurate tool for hospital inpatient is still a challenge for the organizations. We aimed to retrospectively assess the appropriateness of a fall risk prevention program with the STRATIFY assessment tool in detecting acute-care inpatient fall risk.MethodsNumber of falls and near falls, occurred from January 2014 to March 2015, was collected through the incident reporting web-system implemented in the hospital’s intranet. We reported whether the fall risk was assessed with the STRATIFY assessment tool and, if so, which was the judgement. Primary outcome was the proportion of inpatients identified as high risk of fall among inpatients who fell (True Positive Rate), and the proportion of inpatients identified as low-risk that experienced a fall howsoever (False Negative Rate). Characteristics of population and fall events were described among subgroups of low risk and high risk inpatients.ResultsWe collected 365 incident reports from 40 hospital units, 349 (95.6%) were real falls and 16 (4.4%) were near falls. The fall risk assessment score at patient’s admission had been reported in 289 (79%) of the overall incident reports. Thus, 74 (20.3%) fallers were actually not assessed with the STRATIFY, even though the majority of them presented risk recommended to be assessed. The True Positive Rate was 35.6% (n = 101, 95% CI 30% - 41.1%). The False Negative Rate was 64.4% (n = 183, 95% CI 58.9%–70%) of fallers, nevertheless they incurred in a fall. The STRATIFY mean score was 1.3 ± 1.4; the median was 1 (IQQ 0–2).ConclusionsThe prevention program using only the STRATIFY tool was found to be not adequate to screen our inpatients population. The incorrect identification of patients’ needs leads to allocate resources to erroneous priorities and to untargeted interventions, decreasing healthcare performance and quality.

Testing of a Multiple Criteria Assessment Tool for Healthcare Facilities Quality and Sustainability: The Case of German Hospitals

“…The collection took place via survey questionnaires (inter alia [53,54]) or keywords in databases 61% of the time (inter alia [45,55]). The remaining papers had other approaches, for instance, 9% retrospective data collection [56,57] and 9% semi-structured or structured interviews [37,49]. Other collection methods were expert interviews [58], focus groups [59], systematic collections [60], walkthroughs [43], and website data [61].…”

Fall prevention in hospitals and nursing homes: Clinical practice guideline

“…About half of nursing home residents suffer a fall at least once a year (Rapp et al, 2012). Nearly 10% of older patients admitted to hospital units experience falls (Castellini et al, 2017), with more than one‐quarter suffering physical injuries (Anderson et al, 2012; Basic & Hartwell, 2015). In addition to physical consequences, falls also have psychological and social consequences.…”

Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia

“…The list of anticipated risk factors for falls has typically been extracted from medical records or otherwise compiled from patients’ perspectives (Almegbel et al., 2018 ; Alshammari et al., 2018 ). Other researchers have relied on incident reports to identify and describe fall events (Castellini et al., 2017 ; Walsh et al., 2018 ), but these data are mostly lacking in essential details. For example, nurses’ knowledge of the risk factors for falls, as well as of interventions to reduce falls, is rarely documented in the literature.…”