Predicting Falls in Rehabilitation: A Comparison of Three Instruments Including Hester Davis.

PURPOSE: The aim of this study was to evaluate the ability of the Hester Davis Scale (HDS), Section GG, and facility fall risk assessment scores to predict patients who fall during inpatient rehabilitation. DESIGN: This study was an observational quality improvement project. METHODS: Nurses administered the HDS in parallel to the facility's current fall risk assessment and Section GG of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. Receiver operating characteristic curves were compared in 1,645 patients. Relationships of individual scale items to falls were also assessed. RESULTS: The HDS (area under the curve [AUC] = .680, 95% CI [.626, .734]), facility fall risk assessment (AUC = .688, 95% CI [.637, .740]), and Section GG scores (AUC = .687, 95% CI [.638, .735]) adequately identified patients who fell. AUCs did not significantly differ between assessments. HDS scores of ≥13, facility scores of ≥14, and Section GG scores of ≤51 resulted in the highest sensitivity/specificity balance. CONCLUSIONS: HDS, facility fall risk assessment, and Section GG scores adequately and similarly identified patients of mixed diagnoses at risk of falling in inpatient rehabilitation. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses have several options including the HDS and Section GG to identify patients at greatest risk of falling.

COVID-19 and Inpatient Rehabilitation Nursing Care: Lessons Learned and Implications for the Future.

ABSTRACT: The SARS-CoV-2 coronavirus (COVID-19) pandemic is impacting post-acute inpatient rehabilitation nursing practice from preadmission assessment to inpatient care delivery and transition planning. Patients with disability following COVID-19 require interventions to address respiratory, cardiovascular, neurological, musculoskeletal, and psychosocial issues. The pandemic has resulted in changes to program structures and how inpatient rehabilitation facilities approach family caregiver engagement amidst visitation restrictions. Technology solutions can be utilized to reduce the patient and their family's feelings of isolation and support caregiver preparation for discharge. Nurse leaders are essential in supporting staff during this crisis through authentic presence and providing resources and training. Rehabilitation nurses are key in helping patients and families manage rehabilitation and the aftermath of COVID-19 to restore optimal functioning. In this clinical consultation, we synthesize insights learned from the COVID-19 responses at three inpatient rehabilitation facilities. We describe the impact of rehabilitation nursing interventions to improve outcomes for patients with COVID-19 and their caregivers.