Evidence-Based Practice Hendrich Fall Risk

Evidence-Based Practice

Hendrich Fall Risk Assessment Tool

Inpatient falls are common and a leading cause for adverse events in the hospital setting. According to an epidemiological study of hospital inpatients, falls generally range from 2.3 to 7 per 1,000 patient-days with 30% of them resulting in injury and 4% to 6% causing serious injury to the patient (Hitcho et al., 2004). The Hendrich Fall Risk Assessment Model is commonly used to determine the risks of falls based on such predictors as gender, mental and emotional status, symptoms of dizziness and medications commonly associated with increasing risks (Hendrich, Bender, & Nyhuis, 2003). Questions arise, however, concerning the reliability of the predictor and the practicality of using this falls risks assessment on every patient. For all patients entering the hospital, does the Hendrich Fall Risk Assessment Model best determine the risks of patient falls compared with alternative assessment models? The ideal approach to answering this diagnostic question is to perform a prospective, multi-year blinded comparison study.

Extensive research has been conducted to evaluate the effectiveness of current fall risk assessment tools. Tool sensitivity, specificity and positive and negative predictive values are commonly used throughout the literature to evaluate a risk assessment tool. Results of studies have been variable.

A prospective observational study conducted with a cross-sectional patient population in a clinical setting compares the effectiveness of the Hendrich Fall Risk Assessment Model with the Conley Scale, a measuring tool based on slightly different fall risk factors (Lovallo, Rolandi, Rossetti & Lusignani, 2010). The study found that the Conley Scale correctly identified more patients at risk than the Hendrich Model. More specifically, the Conley Score identified more than 60% of patients in the risk-of-falling group who did actually fall. The Hendrich Model, in comparison, only accurately identified 46% of the patients who fell. However, the Conley Score was less specific as it identified a large number of patients at risks who did not fall. From a diagnostic point-of-view, the authors recommend using the Conley Score but recognize that due to the low specificity of its assessment, further evaluation would be necessary to determine appropriate protective measures.

According to another study, the Hendrich Fall Risk Model proves superior to other assessment tools in both sensitivity and specificity in determining at risk patients. The study compared the Hendrich Fall Risk Model with the Morse Fall Scale and the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATISFY) (Neo Kim, Mordiffi, Bee, Devi & Evans, 2007). All tools are based on relative risk assessment of factors including mental and physical impairments. Each, however, uses a different scale and lays different emphases on specific factors, which invariably affects its predictive value. Of particular note is the patient population that each is designed to address. The Hendrich Fall Risk Assessment is most relevant for an acute care setting as it is designed to apply to a diverse patient population.

Consistent throughout previous studies is the concern over the low specificity of the Hendrich Fall Risks Model. It effectively identifies too many positive fall risk patients, which may lead to an overutilization of available resources in implementing intervention measures. A study conducted by Leep Hunderfund et al. tested the effectiveness of a follow-up assessment and risk factor specific intervention measures in reducing falls in an inpatient setting (2011). The study suggested that the Hendrich Risk Fall Model works as an effective primary screening tool and, when used in combination with further physician assessment, reduces the number of patient falls dramatically. Ang, Mordiffi and Wong corroborated these results in a study that demonstrated a reduction in fall rates in response to the implementation of specific intervention measures (2011). The intervention was targeted at risk factors identified by the Hendrich Fall Risk Model and showed how the risk assessment tool could be used effectively with more specific measures to increase specificity.