Classification of Injurious Fall Severity in Hospitalized Adults.
Hospital related
Morbidity
NDNQI
Physical function
Quality of care
Journal
The journals of gerontology. Series A, Biological sciences and medical sciences
ISSN: 1758-535X
Titre abrégé: J Gerontol A Biol Sci Med Sci
Pays: United States
ID NLM: 9502837
Informations de publication
Date de publication:
25 09 2020
25 09 2020
Historique:
received:
18
09
2019
pubmed:
8
1
2020
medline:
17
2
2021
entrez:
8
1
2020
Statut:
ppublish
Résumé
Many hospital systems in the United States report injurious inpatient falls using the National Database of Nursing Quality Indicators categories: None, Minor, Moderate, Major, and Death. The Major category is imprecise, including injuries ranging from a wrist fracture to potentially fatal subdural hematoma. The purpose of this project was to refine the Major injury classification to derive a valid and reliable categorization of the types and severities of Major inpatient fall-related injuries. Based on published literature and ranking of injurious fall incident reports (n = 85) from a large Academic Medical Center, we divided the National Database of Nursing Quality Indicators Major category into three subcategories: Major A-injuries that caused temporary functional impairment (eg, wrist fracture), major facial injury without internal injury (eg, nasal bone fracture), or disruption of a surgical wound; Major B-injuries that caused long-term functional impairment or had the potential risk of increased mortality (eg, multiple rib fractures); and Major C-injuries that had a well-established risk of mortality (eg, hip fracture). Based on the literature and expert opinion, our research team reached consensus on an administration manual to promote accurate classification of Major injuries into one of the three subcategories. The team tested and validated each of the categories which resulted in excellent interrater reliability (kappa = .96). Of the Major injuries, the distribution of Major A, B, and C was 40.3%, 16.1%, and 43.6%, respectively. These subcategories enhance the National Database of Nursing Quality Indicators categorization. Using the administration manual, trained personnel can classify injurious fall severity with excellent reliability.
Sections du résumé
BACKGROUND
Many hospital systems in the United States report injurious inpatient falls using the National Database of Nursing Quality Indicators categories: None, Minor, Moderate, Major, and Death. The Major category is imprecise, including injuries ranging from a wrist fracture to potentially fatal subdural hematoma. The purpose of this project was to refine the Major injury classification to derive a valid and reliable categorization of the types and severities of Major inpatient fall-related injuries.
METHODS
Based on published literature and ranking of injurious fall incident reports (n = 85) from a large Academic Medical Center, we divided the National Database of Nursing Quality Indicators Major category into three subcategories: Major A-injuries that caused temporary functional impairment (eg, wrist fracture), major facial injury without internal injury (eg, nasal bone fracture), or disruption of a surgical wound; Major B-injuries that caused long-term functional impairment or had the potential risk of increased mortality (eg, multiple rib fractures); and Major C-injuries that had a well-established risk of mortality (eg, hip fracture). Based on the literature and expert opinion, our research team reached consensus on an administration manual to promote accurate classification of Major injuries into one of the three subcategories.
RESULTS
The team tested and validated each of the categories which resulted in excellent interrater reliability (kappa = .96). Of the Major injuries, the distribution of Major A, B, and C was 40.3%, 16.1%, and 43.6%, respectively.
CONCLUSIONS
These subcategories enhance the National Database of Nursing Quality Indicators categorization. Using the administration manual, trained personnel can classify injurious fall severity with excellent reliability.
Identifiants
pubmed: 31907532
pii: 5697448
doi: 10.1093/gerona/glaa004
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e138-e144Subventions
Organisme : AHRQ HHS
ID : R18 HS025128
Pays : United States
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.