An implementation of nursing practice changes helped improve the fall rates among patients being treated by the surgical oncology team.
The rollout of a fall prevention plan resulted in a promising reduction in falls among patients who were treated by a surgical oncology team at Baylor University Medical Center, according to results of a study presented during the 47th Annual Oncology Nursing Society Congress.
In August of 2020, the authors determined that the number of falls among this patient population had increased, and that their rate was 8.56 patient falls per 1000 patient days. However, following the fall prevention plan intervention, by December 2020, the fall rate had dropped to 2.28 falls per 1000 patient days. Moreover, in January 2021 and February 2021, there were no patient falls.
In recent years, the number of falls per patient in hospitalized patient has increased. By the year 2030, the costs related to falls are expected to be greater than $100 billion, the authors noted.
To address this problem at their own institution, nurses at the Baylor T. Boone Pickens Cancer Hospital Surgical Oncology unit conducted a preliminary review of fall data. They determined that most patient falls occurred while toileting or during showering. Additionally, the review demonstrated that most falls occurred when the patient was not under nurse supervision; this included when family members or caregivers were assisting the patient instead.
“We chose falls because of the increase of patient falls on our unit and to develop fall reduction strategies to better assist them in managing this,” Bailey Rogers, BSN, RN, said in a presentation of the findings. “We have put together a validation tool that was used to rate the nurse’s knowledge pre- and post-implementation of this project. Some of the different aspects of our project [included] our staff’s ability to use the Johns Hopkins fall tool, how to use a gait belt, educating family using proper [scripts]… and of course staying with the patient the entire time they were in the bathroom.”
The objective behind this implementation was to achieve “zero preventable harm” by concentrating on Nurse-Sensitive Quality Indicators.
Nurses were educated to properly use the Johns Hopkins Fall Assessment Tool to assess patients and determine their fall risk score. Factors determining fall risk score included age, fall history, medications, patient care equipment, mobility, cognition, and bowel or urine elimination. Patients could be marked as either low risk (<6), moderate risk (6-13), or high risk (>13). Nurses were required to assess risk on admission, at least once per shift, upon transfer, or with any changes in a patient’s condition.
Depending on the patient’s risk score, the nurses would then implement elements of the fall bundle to improve patient safety. This included obtaining a fall contract signature from all patients, assigning yellow socks and yellow armbands to at-risk patients, ensuring that all high-risk patients had bed alarms, and appropriately using a gait belt. In addition, these patients would receive education on fall prevention strategies and their utility, an explanation on what makes them more susceptible to falls and how they can try to avoid a potential fall. Nurses would also accompany patients the entire time they visited the toilet—as well as establishing a routine bathroom schedule.
Lastly, nurses were instructed to teach visitors about the importance of assisted toileting by emphasizing safety. Nurses were instructed to take patients to the restroom on purposeful rounds and say “Let me take you to the restroom. I have the time.” The objective behind this approach was to reduce the chance that patients attempt to get up and go to the restroom by themselves.
The nurses would stay within an arm’s reach the entire restroom visit. They were encouraged to explain to the patient that they respect their safety, but that they wanted to eliminate the chance of a fall occurring while they are using the restroom. Nurses would also explain to family and visitors that high-risk patients should be accompanied by staff as opposed to their loved ones. The script that the team used was “Your loved one is at an increased risk for falls while in the hospital and we want to keep them safe, so it is important to call staff to help them to the restroom.”
Some strategies the team implemented after the project included badge buddy cards, scripted signs that were placed within the bathrooms for patients and family members to see, and huddled debriefs after falls to assess how the team could continue to improve their mitigation strategy.
“This project was a success for us, and it was good to see the falls decrease,” Rogers concluded.
Crayton K, Comunez L, Duncan K, Rogers B, Philips E. A participatory program on fall prevention in surgical oncology patients. Presented at: 47th Annual Oncology Nursing Society Congress; April 27–May 1, 2022; Anaheim, CA. Abstract 28