Reducing Falls in the Outpatient Setting

At most hospitals and other inpatient facilities, procedures are in place for identifying patients at risk of falling, and there are guidelines for the prevention of falls. However, such procedures and guidelines are not routinely present in outpatient centers where cancer patients are treated, explained Sara Lantowski, BSN, OCN, of the Smilow Cancer Hospital at Yale-New Haven in Connecticut.

“We had a substantial number of reports of falls at our center, but we had no ambulatory fall screening or prevention plan in our outpatient setting. Since this was an unmet need, as well as a nurse-sensitive indicator of quality, we formed a committee to draft proposals for identifying patients at risk for falls and documenting them in our new electronic medical records system. The next steps are to implement prevention strategies and patient and family education,” said Lantowski.

The simple and easy-to-use Fall Risk Screening Tool that the committee developed includes 4 questions for patients:

  1. Do you use any assistive device to ambulate?
  2. Do you need any physical assistance with standing or walking (ie, walker, cane)?
  3. Do you have periods of forgetfulness or don’t know where you are at times?
  4. Have you had a fall in the past 6 months?

A “yes” answer to any of these questions indicates high risk of falling, she said.
With the use of this new tool, 80% to 100% of patients at Smilow are screened for risk of falls and are identified in the electronic medical record. The screening effort is led by patient care and medical assistants.

“Falls can result in injury, and providing patients with early education on fall risk and prevention would be expected to minimize falls in ambulatory oncology settings [and] the home setting and [would] potentially translate to fewer inpatient falls,” she stated.

The committee has developed an educational brochure for patients that includes steps for preventing falls during outpatient visits (wear nonslip footwear, bring assistive walking devices, wear clothes that allow you to walk freely, and wear your eyeglasses). The brochure in­cludes safety measures for patients to take during outpatient visits, such as asking for help walking if needed, letting the staff know about a recent fall, not using an IV pole as a support, and alerting the staff if there is a slippery floor area or torn carpet.

The brochure also lists fall prevention tips for family members and other visitors who accompany patients on their outpatient visit.

Reference
Blasiak E, Lantowski S, Bursey C, et al. The ins and outs of fall prevention: improving awareness, providing education, and promoting early fall prevention in the outpatient oncology setting. Presented at: 38th Annual Congress of the Oncology Nursing Society; April 25-28, 2013; Washington, DC. Poster 178.

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