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In this
issue
WELCOME
NURSING SCIENCE
Developing the Art of Nursing
Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges
EDUCATION
PRACTICE
Providing Age-Friendly Care through “What Matters Most”
Preventing Burnout through Self-Care and Self-Awareness
PROFESSIONAL DEVELOPMENT
FROM OUR TEAMS
Improving Critical Thinking, Listening, and Communication Skills for The Patient Care Assistant
DiscoveRN UAA Spotlight: Bertha Jones
ABOUT DISCOVERN
EDUCATION
Fall Prevention: Putting Hester Davis Fall Risk Interventions Into Practice
By Brenda B. Charles, DNP, APRN-BC, CCNS, PCCN
By Brenda B. Charles, DNP, APRN-BC, CCNS, PCCN
Hospitals can help diminish falls by incorporating a fall prevention program into their clinical practice. Let’s consider a couple of questions: Do patients participate in fall prevention during their hospital stay? Does the nurse utilize Teach-back to instruct patients and families about pertinent safety information to prevent a hospital fall? The nurse needs to understand the patient’s perception of the importance of fall prevention during their hospital stay. Nurses should also be able to communicate the impact of a fall on a patient’s health and well-being. Prevention of falls requires nurses to not only maintain fall interventions but also teach patients why the interventions are necessary.
The Hester Davis Falls Risk Assessment Scale (HDS) is a comprehensive risk assessment tool that drives care planning based on identified risk factors. The causes of falls may be related to individual factors, such as vision problems, unsteady gait, and weak muscle strength; to environmental characteristics such as poor lighting, clutter, and lack of assistive aids such as grab bars; or even to medications such as blood pressure medications, sedatives, or antidepressants (Centers for Disease Control and Prevention, 2020). Houston Methodist nurses complete an initial patient admission assessment, including the HDS, to evaluate the patient’s chance of falling and document their findings in the Electronic Health Record (EHR). The patient’s fall risk assessment is completed every shift, upon a change in patient condition, transfer to another unit and discharge.
When completed in the EHR, a patient’s specific risk factors will populate the risk level and care plan so nurses can select fall prevention interventions matched to the patient’s risk level. The variables in HDS help formulate an individualized care plan to prevent patient falls. The patient assessment aligns with progressive fall risk interventions, beginning with Universal Fall Precautions for all HM inpatient and outpatient departments. The patient’s fall risk score drives the fall risk intervention scale from low to moderate to high fall risk interventions.
Universal fall precautions are completed for every patient, even if their score is less than 7. Precautions include ensuring call light and belongings are within reach; educating to call and wait for assistance; education of risks to fall; maintaining bed, chairs and wheelchairs in locked and lowest position; ensuring side rails are up; providing adequate lighting and a clutter-free, spill-free environment; keeping closet and bathroom doors closed when not in use; always using no-slip footwear.
The Low Fall Risk Interventions enhance universal fall precautions for patients with a higher risk of falls. These interventions include staying within arm’s reach of the patient while they toilet or shower; instructing the patient and their family to call staff and wait for assistance when getting out of bed; placing a fall risk band and socks on the patient and a green fall precaution sign outside the patient door to ensure every staff member is aware of the patient’s fall risk; and providing patient and family education regarding the risk for falls.
The Moderate Fall Risk Interventions expand on the universal and low-risk interventions by utilizing a yellow fall precaution sign outside the door, placing the patient closer to the nurses’ station, using the call system-connected bed or chair alarm, implementing mobility or mental status interventions for patients scoring two or higher in those sections and placing fall mats on the side of the bed or in front of the chair.
The High Fall Risk Interventions expound on the previous fall risk interventions by adding further interventions based on each section’s score. The high fall risk level adds a red fall precaution sign outside the patient’s room to alert all staff. Interventions include providing assistive devices to patients who use them at home, furnishing bedside commodes for patients requiring one-person assistance and reducing environmental triggers.
The Hester Davis Fall Risk Assessment Scale provides nurses with valuable information about a patient’s risk for falls. However, staff must also apply appropriate interventions to mitigate the fall risk. Suppose a patient scores 2 or greater on any Hester Davis Fall Risk Assessment section. In that case, the nurse should complete appropriate interventions for the patient.
Combining the Hester Davis Fall Risk Assessment and applying appropriate interventions can prevent hospital-associated falls, which can lower the length of stay, unnecessary procedures and diagnostics and ultimately lower the cost of the patient’s hospital stay.
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