Sensitivity and Specificity of the Edmonson Psychiatric ... · Sensitivity and Specificity of the...
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Item type Presentation
Format Text-based Document
Title Sensitivity and Specificity of Edmonson Psychiatric FallRisk Assessment Tool in an Adult Inpatient PsychiatricUnit
Authors Bosse, Jordon; LaPointe, Constance
Downloaded 11-Jun-2018 14:05:13
Link to item http://hdl.handle.net/10755/603255
Sensitivity and Specificity of the
Edmonson Psychiatric Fall Risk Assessment Tool
in an Adult Inpatient Psychiatric Unit
Jordon D. Bosse, RN, MSN/EDPhD Student
University of Massachusetts, Amherst
Constance LaPointe, RN-BCBehavioral Nurse Educator
St. Mary’s Regional Medical Center
Disclosure
At the time the research was conducted, both Jordon Bosse, RN, MSN/ED and Constance LaPointe, RN-BC, PMHC were employed by St. Mary’s Regional Medical Center in Lewiston, ME
Neither author has any conflict or perceived conflict of interest related to this research
Neither author received any sponsorship or commercial support during the course of this research
Background
Behavioral patients fall more often than medical patients (Allen et al., 2012)
Different patient characteristics• Often younger (Tay et al., 2000)
• Often alert (Yates & Tart, 2012)
Unique risks• Med side effects (Tay et al., 2000)
• Sleep disorders (Edmonson et al., 2011)
• ECT (DeCarle & Kohn, 2000 & 2001)
• Labile mental status (Allen et al., 2012)
Repeat falls (Currie, 2008)
Purpose
Sensitivity & Specificity
Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) vs. Johns Hopkins Fall Assessment Tool
RN perception of usability
Phase I
Methods- Retrospective review of 12 cases
- Completed JH and EPFRAT for each
- Two independent raters
Results- 100% agreement on JH scores- 83.3% agreement on EPFRAT scores
Phase II
Methods
- Retrospective review of all falls on adult behavioral unit (n=41)
- JH Score & EPFRAT score
- Matched cases
Results
0
2
4
6
8
10
12
14
16
18
Low John'sHopkins
ModerateJohn's Hopkins
High John'sHopkins
Figure 1 Fall scores of patients who fell
Low EPFRAT
High EPFRAT
Results
0
5
10
15
20
25
30
Low John'sHopkins
Moderate John'sHopkins
High John'sHopkins
Figure 2- Fall scores of patients who did not fall
Low EPFRAT
High EPFRAT
Methods: Phase III
• Piloted for 1 month
• 4 RNs who volunteered
• Filled out EPFRAT on paper
• 161 EPFRAT completed
• Compared to JH score in chart for same shift
Results
0
0.5
1
1.5
2
2.5
JH low JH mod JH high
Figure 3- Comparison of Fall Risk Identification for people who fell during pilot by tool
EPFRAT (High)
EPFRAT (Low)
Results
0
20
40
60
80
100
120
140
JH low JH mod JH high
Figure 4- Comparison of Fall Risk Identification by Assessment Tool for Non-Fallers
Edmonson(High Risk)
Edmonson(Low Risk)
Sensitivity & Specificity
EPFRATJohns Hopkins
Sensitivity 0.80 0.40
Specificity 0.96 0.76
Conclusions & Implications
• Different needs and fall risks by patient population
• EPFRAT more specific for psychiatric patients
• EPFRAT was user-friendly
• Still need to use EB Intervention
• Small sample at one hospital
• Varied understanding of what constitutes a fall
• Discrepancy in reporting (incident vs. in chart)
Limitations & Challenges
Next Steps
- Mandatory training
- Larger scale, prospective evaluation of EPFRAT by adult behavioral health nurses
- Ask staff nurses to complete both EPFRAT and JH fall assessments on every patient