title: Development of an evidence-based fall risk assessment tool and evaluation of interrater reliability and nurses' perceptions of the tool's clarity and usability.
abstract: OBJECTIVE
  To develop and test interrater reliability of an evidence-based fall risk assessment tool for nurses and to investigate how nurses perceived the clarity and usability of the tool.
  
  
  METHODS
  In phase 1, an evidence-based fall risk assessment tool was developed based on a literature review and expert discussion. The finalized tool assessed 11 risk factors and comprised 23 items. In phase 2, reliability testing was done. Two nurses out of a possible 125 participating nurses independently assessed each participating patient on admission with the assessment tool. The nurses then provided feedback on the clarity and usability of the tool. The interrater reliability was estimated by the percentage agreement, Cohen's kappa, and prevalence- and bias-adjusted kappa.
  
  
  RESULTS
  Of the 164 patients who were recruited, 114 patients participated. After adjustment for prevalence and bias, only "frequent urination" and "night-time toileting" showed a less-than-substantial interrater agreement. Assessment of the items "cognitive impairment" and "night-time toileting" were most frequently reported to be problematic.
  
  
  CONCLUSIONS
  The evidence-based fall risk assessment tool requires further modification and re-examination of interrater reliability is warranted. In particular, the cognitive impairment items need to be reconsidered in order to enable nurses to better assess patient cognition on the admission day.
authors.affiliation: Department of Gerontological Nursing, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Higaonna
authors.affiliation: Nursing Department, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Enobi
authors.affiliation: Nursing Department, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D010465:Perception; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D055815:Young Adult
keywords: accidental falls; assessment tool development; inpatients; nursing assessment; reproducibility of the results; risk assessment