By Kristen Bink, MSN, RN, AGCNS-BC
Promoting a culture of safety is the responsibility of all members of the healthcare team. Nurses and advanced practice providers have a unique role in ensuring patient safety, especially through interventions aimed at reducing the risk of falls and falls with injury. Hundreds of thousands of hospitalized patients fall each year, each costing organizations an average additional $14,000 and resulting in more than six additional hospital days. Up to 30% of falls result in injury, including fractures, decreased mobility, and a loss of independence.
Many interventions have not resulted in a significant decrease in falls or injury because of falls’ multifactorial nature, with no single cause to target. Some causes are intrinsic, such as polypharmacy, cognitive status, gait, and balance; others are extrinsic or environmental, including lighting, throw rugs, and cords. Age and functional ability have the biggest impact on fall risk.
Patients with cancer have additional risk factors for falls and injury from falls that should be considered: neuropathy-inducing chemotherapy agents decrease sensory ability, steroids contribute to muscle atrophy and bone loss, and anemia causes severe fatigue. Additionally, thrombocytopenia makes patients susceptible to severe injury, including fatal bleeds, if a fall occurs.
A historical key fall prevention strategy involved restricting ambulation, especially when in a healthcare setting. This, unfortunately, leads to the same domino effect that occurs after a patient sustains a fall: fear of falling, decreased activity leading to weakness and decreased coordination, and more falls. Nurses and advanced practice providers are vital to stopping this sequela. We must learn from ineffective historic interventions used to prevent falls, such as limiting activity, and instead embrace exercise programs and promote safe physical activity.
To safely encourage physical activity, nurses must first understand each patient’s current functional ability. Examples of available tools to assess functional status include the Berg Balance scale, Timed Up and Go test, Sit-to-Stand test, and the Activity Measure for Post-Acute Care. These tools take only a few minutes to perform and can be completed across healthcare settings to track functional ability over time.
Targeted and patient-specific interventions must follow any of these screenings. Interventions should be aimed at maintaining or improving functional status and must meet patients at their current functional level. They may include strength training, exercises to improve balance, appropriate use of assistive devices, or prescribing set times or length of ambulation.
Collaboration with physical and occupational therapy is essential to implement these interventions. Ideally this would occur at the time of cancer diagnosis to maintain functional ability, but it can also happen after changes in functional status are recognized. As those closest to patients, nurses and advanced practice providers must help patients recognize the importance of exercise as a means of maintaining and improving functional ability and thereby reducing falls.