Amy Martinez, BSN, RN, OCN, explains how her team incorporated the Timed-Up-and-Go test into their workflows on a radiology unit.
A nurse-led project based out of the H. Lee Moffitt Cancer Center and Research Institute demonstrated that the Timed-Up-and-Go (TUG) test can be feasibly implemented into routine workflow, helping teams to identify which patients are more likely to fall, and allowing the patients to be referred to the appropriate professionals. The findings were published in the Journal of Clinical Oncology.
In an interview, Amy Martinez, BSN, RN, OCN, who served as the lead author on the study, spoke to Oncology Nursing News about the study and its significance. According to Martinez, oncology nurses can use targeted screening programs to promote patient safety and elevate the quality of care their institution provides.
Using the TUG test, a total of 1,014 patients were assessed for fall risk, including 447 female and 657 male participants, ranging in age from 22 to 96 years. On average, women had a 12.84-second TUG test result and men had a 10.39-second test result.
Ultimately, 10 patients were referred to rehabilitation services based on either their recent fall history or their increasing TUG times. Seven patients were referred to a gait and balance clinic based on their average TUG test results times (average, 15.71 seconds).
The TUG Test
As Martinez explained, the TUG test is an easy-to-conduct performance measure that has been showed to be more accurate than patient-reported functional limitations assessments.
As part of the test, the patient sits in a standard armchair and, once prompted, walks at a normal pace 10 feet away from the chair before returning at a normal pace and sitting down.
The nurse should begin timing the patient as soon as they stand and stop when they return to their seated position. The test should be conducted 3 times, and the average result times should be calculated based on the 3 test results. Patients who take longer than 12 seconds on average are at a higher risk for falling.
“The TUG test is objective test that takes less than 30 seconds to do,” Martinez said.
As part of the intervention, patients completed the TUG test 3 times for their baseline assessment, and the average was entered into their electronic health record. Throughout their treatment, patients continued to perform the TUG test. Time points included at transition of care, change in functional status, if they had a recent fall, and at weekly visits throughout the course of their radiotherapy treatment.
If at any point during their treatment, the TUG test result time increased by at least 10% greater than the baseline assessment, the RN received a notification. Their nurses would conduct a personalized assessment, during which time they would review their patients’ symptoms and educate their patients on how to assess themselves on their own potential fall risk based on STEADI resources.
As Martinez explained, this project was the result of interdisciplinary collaboration, involving stakeholders from the front desk registration staff to the medical assistants, nurses, physical therapists, and radiologists.
“The entire team was involved in the project in some form or fashion,” she said.
Even beyond the cancer clinic, falls pose a risk to older populations. In 2020, 27.5% of older adults reported a fall and 10.2% sustained a fall-related injury.
Patients with cancer who received radiation therapy are more likely to fall as a result of the pharmacologic effects related to treatment. Among patients with cancer, 20% of those 65 years or older reported a fall within the first 6 months since their diagnosis.
In an unpublished internal report at the institution, it was revealed that during a 1-year period, 25% of ambulatory falls were among patients who were undergoing radiation therapy.
As someone who specializes cutaneous oncology, Martinez explained that it was surprising to learn how many patients experience falls as a result of their cancer treatment.
“We knew that the neurological population, or patients receiving radiation to their brain, were at greater risk,” she said. “If you have you a skin cancer on your arm, we don't tend to worry as much, but we do know that radiation causes fatigue after a couple of weeks of radiation, and really all patients are at risk.”
While the ambulatory oncology setting had previously had a fall reduction program in place, Martinez is optimistic that by incorporating the TUG process, nursing practice has been further enhanced and that the quality of patient’s safety will continue to be even more precise going forward.
“The TUG process is now standard of care now in our department,” she said. “It is a valuable piece of information has been embedded in our workflow, and we are proud that we were able to make that change.”
Martinez A, Baxley J, Bergey E, Jennings R, Vonnes C. Interprofessional Approach to Fall Risk Screening in Patients Undergoing Radiation Therapy. Clin J Oncol Nurs. 2023;27(5):565-570. doi:10.1188/23.CJON.565-570