Purpose: Examine unique contributors to falls among hospitalized adult cancer patients with hematologic malignancies.
Significance: Falls represent a major cause of morbidity, mortality, and functional decline in hospitalized adult patients with a cancer diagnosis. In this population, falls may result in various injuries such as bone fractures, loss of independences, and higher medical expenses from increased length of stay. Sequelae of falls may also result in post-fall anxiety with a subsequent increase in dependence on health care providers, and fear of a repeat fall. According to the World Health Organization, an estimated 684,000 individuals die from falls and adults older than 60 years of age suffer the greatest number of fatal falls. Complications that may result from a fall in this population include subdural hematoma, excessive bleeding, and death. The identification of strong fall predictors is essential in implementing an effective fall prevention program.
Method(s): A retrospective case-control study reviewing 94 medical records was conducted to answer the following research question: “What unique predictors of falls exist in hospitalized adult hematology patients?” A convenience sample of 94 participants was drawn from a larger parent study sample of 2,472 individuals who were hospitalized for care associated with leukemia, lymphoma, multiple myeloma, or stem cell transplantation. The parent study examined the impact of a video-based educational intervention on the occurrence of falls among hematology patients hospitalized for the management of cancer treatment and its complications. In this study, the Donabedian’s quality care model served as the conceptual framework to guide the retrospective review.
Result(s): There was no statistical demographic and clinical significance in age, race, gender, underlying diagnoses, and complete blood count (CBC) values. However, there was a statistically significant relationship between fall incident and fall risk assessment score on admission (p = .013). More than half of participants who fell were identified to be at a higher risk for falling (63.6%) than medium fall risk (38%). The three themes of care processes, technology-related interventions, and physical environment modifications provided insight into the proportion of patients who fell with the fall risk assessment score utilizing the Hester Davis scale. A stepwise regression model revealed that fall risk assessment scores were significant predictors of falls in this population. Nurse-reported data on fall prevention procedures demonstrated a lack of consistency in the implementation of required prevention measures on patients who were identified to be at a higher risk of falling.
Implications: Fall prevention research conducted in hospitalized patients has not examined patients with cancer independently to determine why they are at greater risk for falls and fall-related injuries. Ongoing utilization of the Hester Davis scale for fall risk assessment and consistent evaluation and modification of fall prevention measures is imperative for sustainable fall prevention efforts. Recommendations for nurse leaders on fall prevention in hospitalized adult patients with hematologic malignancies include replication of the current study with a larger sample, consistent implementation and monitoring of fall prevention measures, and further studies of fall prevention that include patient engagement and interdisciplinary collaboration in fall prevention efforts.