Pragmatic development of an evidence-based intensive care unit–specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool

Tyndall, A; Bailey, R; Elliott, R

Pragmatic development of an evidence-based intensive care unit–specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool

Tyndall, A Bailey, R Elliott, R

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Publication Type:: Journal Article
Citation:: Australian Critical Care, 2020, 33 (1), pp. 65 - 70
Issue Date:: 2020-01-01

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Field	Value	Language
dc.contributor.author	Tyndall, A	en_US
dc.contributor.author	Bailey, R	en_US
dc.contributor.author	Elliott, R https://orcid.org/0000-0002-9239-7126	en_US
dc.date.available	2019-02-19	en_US
dc.date.issued	2020-01-01	en_US
dc.identifier.citation	Australian Critical Care, 2020, 33 (1), pp. 65 - 70	en_US
dc.identifier.issn	1036-7314	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135824
dc.description.abstract	© 2019 Background: Falls may result in significant patient harm. A recommended strategy to prevent falls is the use of a falls risk assessment tool, but these tools are often specific for older people. Evidence suggests context-specific tools are more effective. Although a rare event in the intensive care unit (ICU), patients in the ICU are at high risk of falling. The primary trigger for the current study was an increase in falls in the study ICU. Aim: The objective of this study was to develop and implement a valid and reliable ICU-specific falls risk assessment tool, with the aim of reducing falls. Methods: Retrospective incident-monitoring database audits were performed. Prospective validity and reliability testing of an ICU-specific tool (Tyndall Bailey Falls Risk Assessment Tool [TB FRAT]) and the existing method for assessing falls risk (ONTARIO Modified Stratify [Sydney Scoring] Falls Risk Screen) was conducted. Seven raters (nurse clinicians) independently performed falls risk assessment using both tools on two occasions for six patients. Results: Correlation for risk stratification categories between the two tools was moderate (r = 0.60, P < .001). Intrarater reliability (correlation) for individual rater's scores was strong (r = 0.86, P < .001). Interrater reliability for the TB FRAT was moderate to excellent (interclass correlations = 0.76 [95% confidence interval: 0.54–0.94]), and internal consistency was excellent (Cronbach's alpha, 0.97). Falls resulting in serious injury reduced from 3.35 per 1000 separations 12 months before implementing the specific ICU tool to 0.85 per 1000 in the 12 months after implementation. Conclusions: The TB FRAT provided a more reliable falls risk assessment than the existing method of assessing falls risk in this single-room occupancy ICU. This TB FRAT could be a valuable addition to quality improvement initiatives aimed at improving patient safety related to falls; however, adaptation to the local context should be considered.	en_US
dc.relation.ispartof	Australian Critical Care	en_US
dc.relation.isbasedon	10.1016/j.aucc.2019.02.003	en_US
dc.subject.classification	Nursing	en_US
dc.title	Pragmatic development of an evidence-based intensive care unit–specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	33	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	33	en_US

Abstract:

© 2019 Background: Falls may result in significant patient harm. A recommended strategy to prevent falls is the use of a falls risk assessment tool, but these tools are often specific for older people. Evidence suggests context-specific tools are more effective. Although a rare event in the intensive care unit (ICU), patients in the ICU are at high risk of falling. The primary trigger for the current study was an increase in falls in the study ICU. Aim: The objective of this study was to develop and implement a valid and reliable ICU-specific falls risk assessment tool, with the aim of reducing falls. Methods: Retrospective incident-monitoring database audits were performed. Prospective validity and reliability testing of an ICU-specific tool (Tyndall Bailey Falls Risk Assessment Tool [TB FRAT]) and the existing method for assessing falls risk (ONTARIO Modified Stratify [Sydney Scoring] Falls Risk Screen) was conducted. Seven raters (nurse clinicians) independently performed falls risk assessment using both tools on two occasions for six patients. Results: Correlation for risk stratification categories between the two tools was moderate (r = 0.60, P < .001). Intrarater reliability (correlation) for individual rater's scores was strong (r = 0.86, P < .001). Interrater reliability for the TB FRAT was moderate to excellent (interclass correlations = 0.76 [95% confidence interval: 0.54–0.94]), and internal consistency was excellent (Cronbach's alpha, 0.97). Falls resulting in serious injury reduced from 3.35 per 1000 separations 12 months before implementing the specific ICU tool to 0.85 per 1000 in the 12 months after implementation. Conclusions: The TB FRAT provided a more reliable falls risk assessment than the existing method of assessing falls risk in this single-room occupancy ICU. This TB FRAT could be a valuable addition to quality improvement initiatives aimed at improving patient safety related to falls; however, adaptation to the local context should be considered.

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http://hdl.handle.net/10453/135824