Cancer Patient Falls

[websterk]

We have been struggling with our fall rate on our inpatient oncology and bone marrow transplant units. We use the Hendrich fall risk assessment tool. More than half of our falls are patients who score low on the falls assessment tool. We already do hourly rounding and use bed alarms, video monitoring and sitters, as appropriate. The problem is that we have so many patient falling who are not high risk and we can't put everybody on a bed alarm. Does anybody have ideas/interventions that have decreased fall rates?

[marialsnd]

We have a lot of falls on our inpatient oncology/renal dialysis unit as well. I've only been there 6 months, but we have yet to go a month without a fall, frequently we don't even get to double digits without a fall. We also do hourly rounding, and in fact about 95% of our patients have both bed checks and chair checks and use rounders/sitters as needed. One thing we all need to remember is using gait belts and lifts more often. It helps to get families on board and not try to transfer patients on their own.

[db2xs]

The first question that comes to my mind: What are they falling on? Do they have an insane amount of IV lines? Are the floors really slippery? If so, are they wearing skid-free socks or shoes/slippers when they get out of bed? If they're using a commode, do they have a skid-free mat under it? Something I always do right after I assess my patients is tell them that I want to make sure they are comfortable and safe while they are here. Therefore, if they're not feeling well, or even if they're feeling well, to please take their time to get up, etc., and that although I'm sure they're Superman/Superwoman at home, there is no judgment here at the hospital if they need help. Then I let them know that it is a lot worse if they fall and injure themselves than if they just call me for help. I have unfortunately had patients fall on me, but they have only been high fall risk patients ... with sitters, to boot!

I think everyone is a fall risk, especially me, because I'm constantly tripping up over myself when I'm walking around outside!

[BD-RN, BSN, RN]

The problem is that we have so many patient falling who are not high risk and we can't put everybody on a bed alarm. Does anybody have ideas/interventions that have decreased fall rates?

If many of the people who are falling were not determined high risk, then you need to assess your scoring method. Patients receiving chemotherapy are usually designated as having a secondary diagnosis that makes them a higher risk for falls. The simplest thing can make a patient fall when they are not in their home environment.

Yes, you can place your patient on a bed alarm whether they like it or not. I tell my patients "we're not used to asking for help to go to the bathroom, so I'm putting this on so that I know when you need assistance." Not to mention they are often on a lot of medications that can effect their balance. Zofran, Ativan, Benadryl... All of those increase your risk for falls. Put on the bed alarm. You're not degrading your patients; you're protecting them.

[greenerpastures]

I'm a bed alarm person too! Pretty much all my patients get one until I know what they can/can't do. However, where I work has a form people can sign to opt out of the bed alarm. You opt out, you fall, not our problem. I don't tell people about that form most of the time. I educate them on the "unfamiliar environment" and how I'm trying to keep them safe. I usually end it with "We both know you want to go home as soon as you can, and a fall usually earns you AT LEAST an extra day, so how about we use this bed alarm just in case?"

The problem is that we have so many patient falling who are not high risk and we can't put everybody on a bed alarm. Does anybody have ideas/interventions that have decreased fall rates?

If many of the people who are falling were not determined high risk, then you need to assess your scoring method. Patients receiving chemotherapy are usually designated as having a secondary diagnosis that makes them a higher risk for falls. The simplest thing can make a patient fall when they are not in their home environment.

Yes, you can place your patient on a bed alarm whether they like it or not. I tell my patients "we're not used to asking for help to go to the bathroom, so I'm putting this on so that I know when you need assistance." Not to mention they are often on a lot of medications that can effect their balance. Zofran, Ativan, Benadryl... All of those increase your risk for falls. Put on the bed alarm. You're not degrading your patients; you're protecting them.