scholarly journals Risk assessment tools available to inform a nurse practitioner’s determination of tolerable risk

2020 ◽  
Author(s):  
◽  
Ricki Smith
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Future Research ◽  
Tolerable Risk ◽  
Risk Assessment Tools

Risk in health care, often discussed in terms of its tolerability, is an abstract term that is patient- and context-specific. An older adult living at risk can be someone falling frequently at home risking a fractured hip, to someone self-neglecting. Family Nurse Practitioners working in Primary Care are well-situated to support patients over time and to mitigate risk. A better understanding of the risk assessment tools available to inform a level of risk tolerability for Nurse Practitioners working in Primary Care may enhance clinical reasoning and enhance their comfort with the concept of risk, resulting in consistent care delivery for patients. Evidencebased literature highlights the complexity of both defining and assessing risk, which is further reflected within the assessment tools. For these reasons, the purpose of this integrative literature review is to provide recommendations, founded in current literature findings, regarding the comprehensive risk assessment tools used to inform a Nurse Practitioner’s determination of tolerable risk for community-dwelling older adults. A search of three databases, as well as hand searches, resulted in nine tools for analysis. The interpretation of the findings suggested that risk assessment tools varied in their approach to risk, with some focused preventatively on risk mitigation while others could be applied in real-time to assess the severity of a perceived risk. Each tool included elements of risk which together, comprise a comprehensive, holistic risk assessment to be considered in the ongoing assessment of tolerable risk. A positive risk-based approach is also a shift in risk perception that Nurse Practitioners are encouraged to consider. The implications for practice include how the described approaches guide decision-making and the definitions of tolerable and intolerable risk can steer the Nurse Practitioner’s care, as well as to inform future research and the development of new risk assessment tools.

scholarly journals MON-391 Implementation of an Osteoporosis Risk Assessment Instrument (ORAI) to Increase Referral Rates for DEXA Scanning in the Primary Care Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Eda Saatciler ◽  
Diane Gillooly ◽  
Bernard Toro ◽  
Peter Lontai
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Primary Care Providers ◽  
Assessment Tools ◽  
Assessment Instrument ◽  
Implementation Phase ◽  
Referral Rates ◽  
Risk Assessment Instrument ◽  
Risk Assessment Tools ◽  
Osteoporosis Risk

Abstract Abstract Background/Purpose: Osteoporosis (OP)was first identified and named by healthcare professionals in the 18th century. Today, OP is still the source of fractures which impair mobility, leading to sub-acute stays at rehabilitation centers. A major obstacle is that primary care providers (PCPs) fail to identify warning signs of OP, and inform patients that Dual Energy X-Ray Absorptiometry (DEXA) scans that are one of the best procedures to assess bone health. This project addressed the issue of low rate of referrals for DEXA scans. Theoretical Framework: The Knowledge-to-Action (KTA) model was used to guide this study. Intervention: Implementation of osteoporosis risk assessment instrument. Methods (Design, Sample, Setting, Measures, Analysis): This includes pre-implementation phase, patients’ charts were reviewed; post-implementation phase, the number of people referred to have DEXA scans were analyzed; the evaluation phase, results compared to the previous data. The project focus exclusively on women and men ages 50 to 89 years in two primary care offices in New Jersey. Descriptive analyses concentrated on whether or not ORAI was the tool to increase DEXA scans. Results: The data analysis reflected that the baseline referral rates increased from 1.3 % to 42 % and patients who scored high on the risk assessment instrument have been referred more often than not. Moreover, patients who are at risk and younger than 65 years of age, risk assessment tools led to a positive referral for a DEXA scan. Those who are older than 65 years, risk assessment tools like ORAI should be given with fracture risk assessment tools. This is especially the case when dealing with men, a demographic group often overlooked in the fight against OP. Conclusions Implications: If this project is to be applied at other clinics, more and more patients would be referred, raising awareness of the medical benefits of early detection. Reasonably, covering a broader section of patients, earlier in their lives, will increase clinical income, bringing more patients to primary care offices.

scholarly journals Practical and validated tool to assess falls risk in the primary care setting: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045431
Author(s):  
Wytske MA Meekes ◽  
Joke C Korevaar ◽  
Chantal J Leemrijse ◽  
Ien AM van de Goor
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Primary Care ◽  
Older People ◽  
Care Setting ◽  
Primary Care Setting ◽  
Predictive Performance ◽  
Assessment Tools ◽  
Falls Risk ◽  
Risk Assessment Tools

ObjectiveAlthough several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently.DesignA systematic review based on prospective studies.MethodsAn extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included.ResultsSix falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%–83.3%, specificity:28.4%–96.6%).ConclusionsGiven that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history.Trial registraion numberThe Netherlands Trial Register, NL7917; Pre-results.

Empowering Effective Teamwork for Machine Risk Reduction in the Workplace

2003 ◽  
Author(s):  
J. R. Etherton
Keyword(s):  
Risk Assessment ◽  
Risk Reduction ◽  
Team Leadership ◽  
Assessment Tools ◽  
Leadership Skill ◽  
Team Members ◽  
Injury Reduction ◽  
Tolerable Risk ◽  
Risk Assessment Tools ◽  
Risk Reduction Measures

The need for teamwork creates new requirements for engineers who use the new ANSI guidelines (B11 TR3-2000) for reducing risks associated with machines. Specifically, the guidelines state that “...a team of involved personnel (e.g., operators, maintenance, engineering) should participate in the risk assessment and reduction effort.” The goal of such teams is to achieve tolerable risk. If they are to be effective team members, engineers will need skills in team leadership; identifying tasks and their associated hazards; using risk assessment tools; developing consensus about degree of risk; and selling the team’s proposed risk reduction measures to management. This paper describes the stages of the TR3 process and focuses on engineering leadership skill development. Leadership must face the challenges of change and instill a sense of trust in the process so that a machine risk assessment team’s injury reduction work can be effective.

A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T

2019 ◽  
Vol 28 (20) ◽  
pp. S4-S8
Author(s):  
Matthew Wynn ◽  
Samantha Holloway
Keyword(s):  
Risk Assessment ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Evidence Base ◽  
Assessment Tools ◽  
Future Research ◽  
Advisory Panel ◽  
Evaluation Tool ◽  
Risk Assessment Tools ◽  
Patients At Risk

The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.

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