The Purpose and Development of the EPFRAT
Inpatient psychiatric facilities face higher fall rates than general hospitals due to factors like psychotropic medication side effects, cognitive issues, and poor nutrition [1.2]. Standard fall risk tools like the Morse Fall Scale aren't sensitive enough to these specific risks [1.2]. Recognizing this, Deborah Edmonson, Sherry Robinson, and Larry Hughes created the Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) [1].
This tool is specifically designed for psychiatric inpatients to more accurately identify and quantify fall risk factors unique to this population [1]. By focusing on these specific variables, the EPFRAT helps healthcare professionals develop targeted fall prevention strategies [1].
The Nine Domains of the Edmonson Scale
The Edmonson scale assesses fall risk across nine domains, each with a weighted score [1.2]. A higher total score indicates greater fall risk. Understanding these domains is essential for proper assessment:
Age
Assesses age, giving higher scores to older patients due to increased fall risk in this group [1].
Mental Status
Uses a detailed scoring system for confusion, disorientation, agitation, and anxiety, which impact awareness and judgment [1].
Elimination
Considers factors like incontinence or frequent urination, which increase the need to rush to the bathroom and raise fall risk [1].
Medications
Emphasizes risks from psychotropic drugs, including recent dosage changes. Many psychiatric medications can cause dizziness or orthostatic hypotension [1].
Diagnoses
Evaluates the impact of psychiatric and medical diagnoses like dementia, delirium, depression, and substance abuse on stability and judgment [1].
Ambulation and Balance
Assesses ability to walk and maintain balance, including the need for assistive devices and the risk of unsteadiness coupled with forgetting limitations [1].
Nutrition
Examines if a patient has had limited food or fluids in the past 24 hours, as poor nutrition leads to weakness and dehydration, increasing fall risk [1].
Sleep Disturbance
Accounts for significant sleep disturbance, which is common in psychiatric patients and can impair judgment [1].
History of Falls
Considers fall incidents within the last three months, a strong predictor of future falls [1].
EPFRAT vs. General Fall Risk Scales
The table below highlights key differences between the EPFRAT and general tools like the Morse Fall Scale [1, 3]:
| Feature | Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) | Morse Fall Scale (MFS) |
|---|---|---|
| Target Population | Inpatient psychiatric patients [1] | General acute care patients [3] |
| Key Focus Areas | Includes unique psychiatric factors: medication side effects, specific diagnoses (e.g., dementia, depression), sleep disturbance, nutritional intake, subtle mental status changes [1]. | Focuses on general risks: history of falling, secondary diagnosis, ambulatory aid, IV therapy, gait, mental status [3]. |
| Risk Factors | Nine domains, with specific attention to psychiatric symptoms [1]. | Six domains, more generalized categories [3]. |
| Mental Status Detail | More nuanced four-point scale [1]. | Simpler two-point scale [3]. |
| Psychometric Properties | Developed and validated specifically for the psychiatric inpatient population [1, 2]. | Validated across general settings but less accurate for specific psychiatric risks [3]. |
Interpreting and Acting on the EPFRAT Score
The EPFRAT provides actionable data. The total score helps classify risk [1]. A score above a certain threshold (e.g., over 90 in early versions) indicates higher risk requiring more intensive prevention [1].
The detailed assessment guides tailored interventions. For high medication risk, focus on monitoring or dosage adjustments. For high ambulation risk, prioritize physical therapy and assistive devices [1]. This precision helps avoid missing critical risks [1].
The Role of the EPFRAT in Patient Safety
Using the Edmonson scale is crucial for patient safety in psychiatric units [1, 3]. It improves the accuracy of risk identification, leading to appropriate precautions and fewer falls and injuries [1].
The tool promotes a holistic view by considering multiple interconnected factors, supporting comprehensive care plans [1].
Conclusion
The Edmonson fall risk scale (EPFRAT) is vital for psychiatric care, offering a specialized method for assessing fall risk in inpatient settings [1]. Its focus on unique psychiatric factors allows for precise, targeted interventions [1]. Using the EPFRAT enhances patient safety, reduces falls, and improves care quality for vulnerable patients [1]. Understanding what is the Edmonson fall risk scale is key to individualized fall prevention in mental healthcare [1]. More details can be found in studies by Edmonson, Robinson, and Hughes, and others [1, 2, 3, 4].
Development of the Edmonson Psychiatric Fall Risk Assessment Tool
