SPECIAL SESSION: Sustaining Evidence-Based Nursing Practices for Fall Prevention in Hospitalized Oncology Patients
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Session presented on Saturday, July 26, 2014: Aim: This study aimed to identify factors that sustain evidence-based fall prevention for hospitalized oncology patients by examining patient factors (characteristics reported in incident reports 2009-2012 and patient interviews regarding their perspectives of fall risks and prevention); nursing interventions (documented for patients who fell 2009-2012); and nursing staff surveys regarding fall prevention knowledge and self-efficacy. Background: Fall prevention is an important quality indicator and nursing concern for hospitalized oncology patients. In fact, 3-20% of hospitalized patients fall with 60% related to toileting, adding $4000 in cost. Up to 50% of patients are at risk and almost half who fall suffer injuries. Fractures account for 35% of nonfatal injuries but 61% of costs. Cancer patients who fall often experience severe injuries due to underlying medical conditions. Falls add to length of stay, costs and fear of falling leading to less ambulation, which contributes to weakness, imbalance and further risks. Hospital fall prevention must address both patient risk factors and context. Limited evidence exists to specifically guide fall prevention for oncology patients. Moreover, capturing patients' perceptions is important but largely missing. Sample/Methods: Human subjects' protection approval was obtained from the IRB. A convenience sample of 39 adult oncology patients hospitalized less than 3 days, receiving inpatient cancer treatment, and communicated in English were interviewed regarding fall risk, fall prevention, getting assistance, communication with the team, routine nursing assessment, and use of equipment to prevent falls. Oncology nursing staff (n=52 registered nurses [RNs], 18 nursing assistants [NAs]) completed a survey on self-efficacy and knowledge of fall prevention and an AHRQ context assessment. Descriptive statistics were used to summarize findings. Results: Patients averaged 58.9 years of age, 36% report falling in the past five years, 18% with injury; however, 56% reported not being at fall risk while hospitalized. Yet, 77% reported an injury risk if they fell during hospitalization; and 36% reported assistance to the bathroom was not at all important. Patients' identified being careful (30%) and getting help (30%) as important. Only 27% of RNs and no NAs report involvement in interdisciplinary planning for fall prevention; 65-83% of RNs and NAs reported consistently using safe-handling equipment; 56-62% of RNs and NAs report ambulating patients to reduce fall risk; and 72-87% indicate hospital leaders are engaged in fall prevention. 25% of RNs and 39% of NAs reported they leave patients alone in the bathroom to provide privacy. Conclusions: Oncology patients have unique perceptions about fall prevention that may not match the evidence. Consistent use of evidence-based fall prevention can be challenging. Interdisciplinary planning for fall prevention, and the NA role were under-utilized. Fall prevention has been largely relegated to nursing. Clinicians must merge patient perspectives and EBP recommendations within daily interdisciplinary planning. Implications for practice: Effective fall prevention is needed for hospitalized oncology patients. Practices that engage patients in understanding their risks along with collaborative individualized fall prevention strategies are needed and effects of these practices need further study. More effective training is also needed for fall prevention that engages all interdisciplinary team members.