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Validating Fall Prevention Icons to Support Patient-Centered Education

Leung, Wai Yin MS*; Adelman, Jason MD; Bates, David W. MD, MSc*; Businger, Alexandra MPH*; Dykes, John S. MFA§; Ergai, Awatef PhD; Hurley, Ann DNSc, RN*; Katsulis, Zachary BS; Khorasani, Sarah BS*; Scanlan, Maureen MSN, RN; Schenkel, Laura BS; Rai, Amisha PA-C, MHS; Dykes, Patricia C. PhD, MA, RN*

doi: 10.1097/PTS.0000000000000354
Original Article: PDF Only

Introduction Falls with injury are the most prevalent hospital adverse event. The objective of this project was to refine fall risk and prevention icons for a patient-centric bedside toolkit to promote patient and nurse engagement in accurately assessing fall risks and developing a tailored fall prevention plan.

Methods Eighty-eight patients and 60 nurses from 2 academic medical centers participated in 4 iterations of testing to refine 6 fall risk and 10 fall prevention icons. During individual interviews, participants rated their satisfaction with the degree to which that icon represented the concept on a 4-point Likert scale, enabling computation of a Content Validity Index (CVI), and provided comments and suggestions for improvement. After reviewing CVI scores and feedback, the research team consulted with the illustrator to revise the icons.

Results Content Validity Index scores improved after icon modifications. Icons that depicted multiple concepts required further iterations to be acceptable.

Discussion Using icons to depict an accurate and easy-to-interpret fall risk assessment and intervention plan for all care team members including patients and family to follow should lead to improved adherence with that plan and decreased falls.

Conclusions All 16 icons were refined and used to form the basis for a bedside fall prevention toolkit.

From the *Brigham and Women's Hospital, Boston, Massachusetts; †Montefiore Medical Center, Bronx, New York; ‡Healthcare Systems Engineering Institute at Northeastern University, Boston; and §John S. Dykes Illustration, Sudbury, Massachusetts.

Correspondence: Patricia C. Dykes PhD, MA, RN, Division of General Internal Medicine, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02134 (e-mail:

Supported by Agency for Healthcare Research and Quality (Grant Number P30HS023535, 2014).

The authors disclose no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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