Falling became part of American pop culture communication or sensory deficits and behavioral humor in the early 1990s with the line “I’ve fallen and issues. Based on the score, patients are identified as a fall I can’t get up!” from a TV commercial for a medical risk or not, and, if so, are categorized as high, medium alarm company. or low risk. Falls are no laughing matter at UAMS Medical Center Once the scale is completed and the patient care – or any hospital – where the average additional cost of staff knows whether the patient is at risk for falling, an injury sustained from a fall is nearly $25,000. appropriate intervention measures can be put into place, With the stakes so high, most hospitals have protocols, individualizing nursing care for the patient. policies and measures in place to prevent falls. Yet, they “The reason this program has been so successful is happen every day at hospitals around the world. because of our nursing staff’s commitment to quality For decades, UAMS was like most other hospitals, care and because we live a culture of safety at UAMS,” taking precautions, offering staff training and monitoring Hester said. falls. The numbers varied a little month-by-month, but “We’ve learned through use of the Hester-Davis Scale nothing was really working to dramatically decrease the that it’s really important why the patient is at risk for falling,” number of patients who fell while in the hospital. said Davis. “What works to help one patient may not work That is, until January 2010 when Clinical Services for another. For example, patients who are impulsive are Manager Amy Hester, R.N., and typically not going to respond to bed Advanced Practice Partner Dees Davis, alarms that signal our nursing staff when We presented the patient gets out of bed. They usually R.N., implemented the research project they had been working on for nearly a the results of our just ignore it and continue on. What year and a half. Their research resulted in often works best for these patients is to pilot project at a the Hester-Davis Scale, a risk-assessment encourage family members to stay in the tool that identifies patients most likely to room as much as possible, engage patients national safety fall, and, more specifically, the reason for daily activities and encourage them to conference last in the fall risk and appropriate interventions express their feelings.” fall, and it just for the nurse to implement. The success of the Hester-Davis Scale Use of the Hester-Davis scale resulted in an in-patient setting using paper forms went viral.” in a 20 percent decrease in the number of has motivated Hester and Davis to want falls across the hospital and a 40 percent to make additional improvements and decrease in injuries in six months beginning in March expand application of the tool to other settings. “Our next 2011. “These results are phenomenal in the world of step is to test and validate our results in an environment patient quality statistics,” said Dr. Nicholas Lang, medical with electronic records rather than the paper forms we’ve director for UAMS Medical Center. “Amy and Dees are used so far,” explained Hester. “Then, the possibilities are great examples of our constant work to improve patient limitless. Just think of what this approach could mean in safety, and their research has had a positive impact not an outpatient setting. only on patients at UAMS but at other hospitals around “Clinic staff can complete the form with the help of an the country.” elderly patient’s family and caregivers to identify behaviors, “We presented the results of our pilot project at a medications and other factors that can increase a patient’s national safety conference last fall, and it just went viral,” fall risk. With this information and an assessment of the said Hester. “It spread so fast we couldn’t keep track of patient’s fall risk, we can provide strategies and resources all the facilities using it. We know of organizations in 20 for the family to prevent falls at home.” states who’ve made inquiries directly from us, and there “And, it’s not just limited to falls,” adds Davis. “This are others who’ve adopted it based on the experiences of same approach can be used for lots of other health care these facilities without contacting us.” issues like allergy triggers or diabetes management.” The Hester-Davis Scale has nine sections and takes “We started this because we wanted to help our patients,” about a minute to complete. The sections include age, said Hester. “And, based on the feedback we’ve received, last known fall date, mobility, medications, mental status we know we’ve done the right thing. The possibility of and awareness, toileting needs, nutritional needs, helping even more patients is very exciting.”
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