Characteristics of Cancer Patients Who Fall: A Two Year Review and Analysis of Patient Safety Net Oncology Fall Reports

Purpose:
To identify various evidence sources related to falls in an oncology population.

Background/Significance:
One in three people >65 years have had a fall. 16,000 people die per year as a result of fall-related injuries. Despite interventions, University of Colorado Hospital's (UCH) fall rates are consistently higher than the NDNQI benchmark, specifically oncology fall rates. Factors that influence falls are: history of previous fall, toileting difficulties, and/or taking >4 different medications. Additional risk factors exist for cancer patients: insomnia, deconditioning, and neurological deficits.

Methods:
An extensive review of literature was conducted to determine if there were any supporting evidence or successful interventions undertaken to decrease fall rates in an oncology population. Additionally, a review of Patient Safety Net oncology fall reports was undertaken for the past two years. Charge RN sheets were examined for additional patient information related to the falls. All audit data were entered into an Excel file and imported into a SPSS database. Data were analyzed using descriptive statistics, tests of difference and association.

Results:
Positive risk factors documented in PSN reports (N=117) associated with falls include toileting (70.5%), the presence of an IV pole (62.8%), receiving chemotherapy or biotherapy (56.1%), and dizziness at the time of the fall (40.4%). Additional outcomes from this analysis include: more falls occurred on the night shift (54.9%), change of shift was not a factor in fall risk, more falls occurred in rooms located closest to the nursing station (44.0%), bed alarms were not used in the majority of cases (79.8%), toileting was the most common risk factor associated with falling, and significant relationship exists between dizziness and falling in BMT patients (p=0.27).

Conclusions and Implications for Practice:
Increased education was done with staff about factors influencing fall rates. The formation of RN assignments changed from solely looking at patient acuities, to also assigning RNs “blocks” of rooms located within close proximity. Chemotherapy was added to the hospital wide fall acuity tool.