IHE Detailed Proposal

1. Proposed Profile: Falls Risk Scale

  • Proposal Editor: Marcia Veenstra
  • Profile Editor: Keith Boone
  • Date: Nov. ’08
  • Version:
  • Domain: Patient Care Coordination

Summary

Healthcare costs for falls in 2003 were reported to be 19 billion for hospitalizations, 15 billion for Emergency care and 4 billion for Outpatient care.CDC estimates by 2020 falls will cost 54.9 billion annually. In an effort to provide improved care and minimize risk and cost of care, Joint Commission National Patient Safety Goals for 2008 include the implementation of a fall risk reduction program. Assessment of fall risk should be completed at the initial point of care,on admission, at each condition change and at each transfer.

Client requests encourage vendor support and integration of risk scales to be transferable as care is transferred from provider to provider. Healthcare costs are reduced, adverse events avoided and patient satisfaction increased.

2. The Problem

At the present time, nursing assessments are not interoperable, except as demonstrated within the Functional Status assessment (FSA). This profile will continue the FSA work. The Morse Falls Scale is used internationally.

Nursing assessments are necessary to ensure safe, quality patient care, as assessments are a record of patient status at one point in time. Comparison of multiple assessments of an individual allows nurses to think critically to prevent complications.

Development of evidence based scales for risk reduction is highly regarded in the marketplace. But assessment scales must use standards to be interoperable to demonstrate outcomes with patient transfer. Scales used to indicate risk could define transactions for actors to collect, analyze and display outcomes of management. This profile would continue this work.

3. Key Use Case

An 80 year “young” man is admitted for abdominal surgery. The nurse notices it takes multiple attempts for him to stand prior to changing into a hospital gown, but notes he walks without assistance. In the evening after surgery, pain medications are given by patient controlled analgesia (PCA) pump. The patient is confused but able to be reoriented easily. During the first night post operative, he falls attempting to use the urinal at the side of the bed.

Proposed use case: A fall risk assessment is done at the time of admission. Data noted for risk is that post op will use PCA pump for pain, age, risk of disorientation/confusion, multiple attempts were needed to stand prior to surgery indicates potential weakness. A fall risk scale is used to indicate interventions to be added to the patient care plan, which will be needed to manage risk of falls. At each transfer of care, the scale will be reviewed by content creator and content consumer.

IHE Detailed Proposal-Falls Risk Scale

4. Standards & Systems

  • Fall risk scales will be LOINC and SNOMED coded for interoperability. Use of valid and reliable, evidence based fall risk scales can be standardized in much the same way as other scales (pain, Braden) and expected use per protocols will support early planning and interventions.
  • HL7, XDS-MS, CDA, CCR, CCD

5. Technical Approach

Existing actors: Content Creator, Content Consumer

  • Healthcare Information Systems
  • Healthcare Documentation System
  • Electronic Medical Record Systems
  • Personal Health Record Systems
  • Computerized Provider Order Entry Systems
  • Clinical Information Systems

Physician, nurses and alliedhealthprofessionals involved in caremay be either content creator users or consumerusers and will plan preventive interventions to reduce or manage fall risk based on past assessments and plans for condition changes.

New actors: None known at present

Existing transactions

New transactions (standards used)

6. Support & Resources

Nursing Subcommitteegroup with MFSwill be working with Detailed Scales profile and Coded Clinical Documentation. More vendors will need to be recruited.

7. Risks

Morse Falls Scale must be used as published. Alteration will affect validity of scale. Scale will be used in Showcase without charge. Vendors desiring to add the MFS to their product must contact Janice Morse for a IP permission/contract .

8. Open Issues

9. Tech Committee Evaluation

Effort Evaluation

Responses to Issues

Candidate Editor

References:

CDC: retrieved 9/08/ 08 from

Morse, J. M. (2002). Enhancing the safety of hospitalization by reducing patient falls. American Journal of Infection Control, 30(6), 376-380.

Morse, J. M. (2001) Preventing patient falls in the elderly. Reflections on Nursing Leadership. 27(1), 26-27.

Morse, J. M. (1998) Predicting fall risk [Letter to the editor]. Canadian Journal of Nursing Research, 30(2), 11-12.

Morse, J. M. (1997). Preventing patient falls.Newbury Park, CA: Sage.

Morse, J. M. (1993). Nursing research on patient falls in health care institutions. Annual Review of Nursing Research, 11, 299-326.

Morse, J. M., Morse, R. M., & Tylko, S. (1989). Development of a scale to identify the fall-prone patient. Canadian Journal on Aging, 8(4), 366-377.

Morse, J. M., Black, C., Oberle, K., & Donahue, P. (1989). A prospective study to identify the fall-prone patient. Social Sciences & Medicine, 28(1), 81-86.

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IHE Detailed Proposa Falls Risk Nov 08