Keeping Patients Safe 2018-04-30T14:09:29+00:00

Safety In Numbers

By Kate Franks

Melinda Barbee, RN, is one
of the trained staff members
at UAMS who assess
patients for fall risk and
then implement appropriate
measures to ensure they
don’t fall while at
the hospital.

Falling became part of American pop culture
humor in the early 1990s with the line “I’ve fallen and
I can’t get up!” from a TV commercial for a medical
alarm company.

Falls are no laughing matter at UAMS Medical Center
– or any hospital – where the average additional cost of
an injury sustained from a fall is nearly $25,000.
With the stakes so high, most hospitals have protocols,
policies and measures in place to prevent falls. Yet, they
happen every day at hospitals around the world.

For decades, UAMS was like most other hospitals,
taking precautions, offering staff training and monitoring
falls. The numbers varied a little month-by-month, but
nothing was really working to dramatically decrease the
number of patients who fell while in the hospital.

That is, until January 2010 when Clinical Services
Manager Amy Hester, R.N., and
Advanced Practice Partner Dees Davis,
R.N., implemented the research project
they had been working on for nearly a
year and a half. Their research resulted in
the Hester-Davis Scale, a risk-assessment
tool that identifies patients most likely to
fall, and, more specifically, the reason for
the fall risk and appropriate interventions
for the nurse to implement.

Use of the Hester-Davis scale resulted
in a 20 percent decrease in the number of
falls across the hospital and a 40 percent
decrease in injuries in six months beginning in March
2011. “These results are phenomenal in the world of
patient quality statistics,” said Dr. Nicholas Lang, medical
director for UAMS Medical Center. “Amy and Dees are
great examples of our constant work to improve patient
safety, and their research has had a positive impact not
only on patients at UAMS but at other hospitals around
the country.”

“We presented the results of our pilot project at a
national safety conference last fall, and it just went viral,”
said Hester. “It spread so fast we couldn’t keep track of
all the facilities using it. We know of organizations in 20
states who’ve made inquiries directly from us, and there
are others who’ve adopted it based on the experiences of
these facilities without contacting us.”

The Hester-Davis Scale has nine sections and takes
about a minute to complete. The sections include age,
last known fall date, mobility, medications, mental status
and awareness, toileting needs, nutritional needs,
communication or sensory deficits and behavioral
issues. Based on the score, patients are identified as a fall
risk or not, and, if so, are categorized as high, medium
or low risk.

Once the scale is completed and the patient care
staff knows whether the patient is at risk for falling,
appropriate intervention measures can be put into place,
individualizing nursing care for the patient.

“The reason this program has been so successful is
because of our nursing staff’s commitment to qualitycare and because we live a culture of safety at UAMS,”
Hester said.

“We’ve learned through use of the Hester-Davis Scale
that it’s really important why the patient is at risk for falling,”
said Davis. “What works to help one patient may not work
for another. For example, patients who are impulsive are
typically not going to respond to bed
alarms that signal our nursing staff when
the patient gets out of bed. They usually
just ignore it and continue on. What
often works best for these patients is to
encourage family members to stay in the
room as much as possible, engage patients
in daily activities and encourage them to
express their feelings.”

The success of the Hester-Davis Scale
in an in-patient setting using paper forms
has motivated Hester and Davis to want
to make additional improvements and
expand application of the tool to other settings. “Our next
step is to test and validate our results in an environment
with electronic records rather than the paper forms we’ve
used so far,” explained Hester. “Then, the possibilities are
limitless. Just think of what this approach could mean in
an outpatient setting.

“Clinic staff can complete the form with the help of an
elderly patient’s family and caregivers to identify behaviors,
medications and other factors that can increase a patient’s
fall risk. With this information and an assessment of the
patient’s fall risk, we can provide strategies and resources
for the family to prevent falls at home.”

“And, it’s not just limited to falls,” adds Davis. “This
same approach can be used for lots of other health care
issues like allergy triggers or diabetes management.”

“We started this because we wanted to help our patients,”
said Hester. “And, based on the feedback we’ve received,
we know we’ve done the right thing. The possibility of
helping even more patients is very exciting.”