FRATs are designed to identify both persons at high risk of falls and to allow for cost-effective targeting of fall prevention strategies. This study compares two FRATs (BHS FRAT and TNH-STRATIFY) for accuracy of predicting falls and targeting of fall prevention strategies in a sub-acute hospital. Comparisons of retrospective audit data over two periods (use of the BHS-FRAT; post TNH-STRATIFY implementation) were used in the evaluation (n=362). Inter-rater reliability of the TNH-STRATIFY was evaluated from independent assessment by two nurses for 30 sub-acute patients and using intraclass correlation coefficient (ICC2,1). Event rate (ER) and standard measures of predictive accuracy were calculated for both FRATs. The proportions of patients with documented fall prevention strategies addressing identified fall risk factors were compared between audit phases. The TNH-STRATIFY had high inter-rater reliability (ICC2,1=0.96). The BHS-FRAT and TNH-STRATIFY demonstrated poor predictive accuracy using recommended high risk cut-off scores, with low specificityER (0.07 and 0.13 respectively) and very low Youden IndexER (0.04 and 0.07 respectively), although these measures improved using modified cut-off scores. Positive and negative predictive values were moderate for the BHS-FRAT (0.51, 0.64) and TNH-STRATIFY (0.52, 0.61). The falls rate and proportion of recurrent fallers did not change between audit phases. Implementation rates for prevention strategies for key risk factors were higher following implementation of the TNH-STRATIFY. The results indicated that the TNH-STRATIFY, combined with associated nursing care plan falls documentation, improved the targeting of prevention strategies for key risk factors such as cognitive impairment, incontinence and mobility impairment.
Understanding the perceptions of stakeholders is critical for determining acceptability and feasibility of volunteer-mediated programs. This study evaluated the feasibility and acceptability for staff, volunteers, patients and their carers, of a volunteer diversional therapy program for patients with cognitive impairment undergoing inpatient rehabilitation. Post-program structured interviews were conducted with the volunteers (n = 10), patients (n = 30) and their carers (n = 3); and nursing staff (n = 6) participated in a focus group. Thematic analysis identified five themes (values, attitudes, knowledge, purpose, support) in two dimensions (personal, team culture). Overall, patients, carers, staff and volunteers were satisfied with the volunteer program and perceived benefits for quality of care. Recommendations for improvements to the program related to staff engagement with the program and the volunteers' education and training. The volunteer diversional therapy pilot program for patients with cognitive impairment on a sub-acute ward was acceptable and feasible for patients, carers, staff and volunteers. (C) 2014 Mosby, Inc. All rights reserved.