Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting

Kim, Young Ju; Choi, Kyoung‐Ok; Cho, Suk Hyun; Kim, Seok Jung

doi:10.1111/jocn.16185

Cited by 19 publications

(17 citation statements)

References 21 publications

(69 reference statements)

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“…The patients' fall risk was evaluated using the JHFRAT 8 . This is a widely used, valid, and reliable tool for fall risk stratification during hospitalization for the adult population 16,17 . The JHFRAT includes seven items considered to influence the risk of falls including age, fall history, urinary frequency and/or incontinence, medications (e.g., PCA/opiates, anticonvulsants, anti‐hypertensives, diuretics, hypnotics, laxatives, sedatives, and psychotropics), equipment that tethers patient (e.g., lines, tubes), mobility, and cognition.…”

Section: Methodsmentioning

confidence: 99%

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

Capó-Lugo

Young

Farley

et al. 2023

J American Geriatrics Society

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Background Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. Methods We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non‐ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post‐Acute Care (AM‐PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM‐PAC, comorbidity count, and length of stay. Results 8% of patients at low risk for falls were non‐ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9–5.5) and 2.6 (95% CI: 2.4–2.9) times more likely to be non‐ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM‐PAC 18–24), those categorized as high risk for falls were 4.3 (95% CI: 3.5–5.3) times more likely to be non‐ambulatory compared to patients categorized as low risk. Conclusions Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.

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Section: Methodsmentioning

confidence: 99%

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

Capó-Lugo

Young

Farley

et al. 2023

J American Geriatrics Society

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“…If a patient had fallen, the last fall risk level before a fall was extracted for the predictive validity analysis. If the patient had not fallen, the highest fall risk level was extracted (Kim et al, 2022). Predictive validity of the two fall assessment methods were sensitivity (high‐risk patients among fallers), specificity (non‐high‐risk patients among non‐fallers), positive predictive value (PPV, among high‐risk patients who fall), and negative predictive value (NPV, among non‐high‐risk patients who never fall) (Poe et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

“…The caliper value was taken as 0.02, and the 1:1 adjacent matching method was used to screen patients from the control group. To analyze the predictive validity of the two methods, the sensitivity, specificity, PPV, and NPV were calculated using the data before PSM (Kim et al, 2022). Also, the area under the receiver operating characteristic curve (AUC) was analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…Studies have shown that removing a scoring system was unlikely to impact the fall rate and had the potential to reduce nursing administration time (Jellett et al, 2020; Morris et al, 2021). Kim et al (2022) analyzed data classified as the direct low‐ or high‐risk group without item measurements in an acute care setting and found that the multifactor fall assessment more accurately reflected the changeable conditions in fall risk measurement.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a concise fall risk stratification among older adults with cataracts in day surgery settings: A historically controlled study

Wang,

Dai,

Ou‐yang

et al. 2023

Japan Journal Nursing Sci

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AimThis study aimed to evaluate the use of a concise fall risk stratification in assessing and predicting falls compared with the Morse Falls Scale among older adults with cataracts in day surgery settings.MethodsA historically controlled study conducted from July 2020 to June 2022 was used in a municipal ophthalmic hospital in China. The concise fall risk stratification which directly graded fall risk by multifactorial judgment was used during the intervention period, while the Morse Falls Scale which graded fall risk by scale scores was used during the control period. The fall risk levels, fall assessment time, fall rates, fall‐related injuries, predictive validity, and patient satisfaction with day surgery care were extracted. Propensity score matching was performed to balance baselines.ResultsAfter matching, 4132 patients were included in the final analysis. Compared with the control group, the intervention group had significantly higher assessment results for fall risk level, a significantly shorter (by 48.15%) fall assessment time, and higher patient satisfaction. There were no differences in fall rates and fall‐related injuries. Compared with the Morse Falls Scale, the concise fall risk stratification had higher sensitivity and negative predictive validity, and lower specificity and positive predictive validity, while the area under curve did not differ significantly.ConclusionThe use of the concise fall risk stratification reduced fall assessment time, improved patient satisfaction, and is unlikely to impact falls with an overall predictive performance comparable to that of the Morse Falls Scale for older cataract adults in day surgery settings.

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“…A total of nine tools were used to assess patients' fall risk in medical institutions. Commonly used tools included the Morse Fall Scale (MFS), Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT), Hendrich II Fall Risk Model (HFRM II), Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRA), and St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) [30][31][32][33][34][35][36][37][38]. The sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Youden index, determined with study-specific cutoff scores, are shown in Table 2.…”

Section: Fall Risk Assessmentmentioning

confidence: 99%

Falls in Patients of Medical Institutions in South Korea: A Literature Review

Choi

2023

Physical Therapy Korea

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Falls Inpatients Prevention Risk assessmentBackground: Like many other countries, falls and related injuries in older adults are great concerns in South Korea. In particular, falls are common in medical institutions, often causing the increase of the length of hospitalization. Objects:The purpose of this review was to help understand and address falls in hospitalized individuals in South Korea. Methods:The review was conducted on literature published in Korean from 2010 to 2022, searched in the Korea Citation Index and PubMed. Keywords used for the search were as follows: falls, fall risk, fall risk assessment, hospital, inpatient, intervention, Korea, and prevention.Results: A total of 54 articles were found and reviewed. The most common place of fall accidents was the inpatient room, where there were many cases of falls while walking. Loss of balance was the most common cause of falls, and many falls occurred in patients admitted to the internal medicine. Furthermore, a risk of falling increased with the type of medications taken. In terms of tools to assess patients' fall risk, the Morse Fall Scale (MFS) was commonly used. Patient-specific fall prevention activities were common to address falls, and they decreased the frequency of falls and the fear of falling. Factors influencing the effectiveness of the fall prevention activities included attitudes toward falls, education, environmental factors, patient safety culture, and self-efficacy in preventing falls. Conclusion:Our results should help understand and address falls and injuries in medical institutions.

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Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting

Cited by 19 publications

References 21 publications

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

Revealing the tension: The relationship between high fall risk categorization and low patient mobility

Evaluation of a concise fall risk stratification among older adults with cataracts in day surgery settings: A historically controlled study

Falls in Patients of Medical Institutions in South Korea: A Literature Review

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