A Program to Reduce Falls in a Major Cancer Center: A Two-Year Follow-up

Purpose:
At a comprehensive cancer center, reducing falls was identified as a high safety priority, and a nursing-led interdisciplinary performance improvement team was established to determine and execute fall-reduction strategies. This presentation highlights key compenents and outcomes of the program.

Significance:
Falls and related injuries present considerable danger to oncology patients and are the leading cause of injuries sustained by hospitalized patients. Due to the nature of the patient's underlying medical condition, injuries sustained as result of patient falls in a cancer hospital can be severe.

Strategy and Implementation:
Based on findings from a case-control study, the team developed and pilot tested an assessment tool to identify patients at risk for falling and then refined the tool for hospital-wide use after psychometric testing was complete. Following the roll-out of the tool, a demonstration project was initiated on the hospital's orthopedic and neuro-oncology unit in March 2007. The program sought to implement a new model of care delivery related to patient safety, and specifically, to reducing patient falls. All nursing staff from the unit, including nurse practitioners, staff nurses, and ancillary staff, participated in one of three day-long training sessions, developed and presented by fellow staff members. The focal point of the sessions is creating a culture of safety on the unit. Lectures on patient safety theory, teamwork, delegation, and quality assessment are presented along with several group activities and hands-on demonstrations.

Evaluation:
Unassisted falls dropped from 4.90 (p/1000 pt days) prior to the program to 2.96 after. Two years later, the rate shows a steady decline. Circumstances surrounding falls have changed: of note, 67% of falls prior to the program occured while toileting; now, just 33% of falls are toileting-relating.

Implications for Practice:
Analysis comparing post-fall diagnostic radiology orders prior to and after the program revealed both fewer CT scans and x-rays in the latter, demonstrating tangible cost savings. Educational training is ongoing so that every provider on the unit has been exposed to the program.