SAN DIEGO—A program that calls for direct communication between interdisciplinary caregivers may help decrease falls in a hematology/oncology inpatient unit, according to data reported by Boston researchers.
Deborah O’Connor, RN, MS, CNML, at the Brigham and Women’s Hospital in Boston, and her colleagues presented the results of a falls prevention program that was “piloted” in a hematopoietic stem cell transplant (HSCT) unit at a tertiary academic teaching hospital.
The intervention involved collaboration between nurses, physician/physician assistants (PAs), and pharmacists. “While fall prevention is frequently considered the responsibility of nursing staff, all members of the healthcare team have a role in maintaining patient safety,” said O’Connor, who is nursing director of hematology/oncology.
Nurses assess fall risk in high-risk patients at least once during both the day and night shifts using the Morse Fall Scale. Nurses note on the patient’s chart if the patient’s score exceeds 45, which indicates a high risk of a fall. The score is later communicated to the nurse in charge of that patient on the next shift. Each day-shift nurse caring for a highrisk HSCT patient initiates a discussion of safety measures during the morning rounds with other members of the HSCT team.
Sara Close, PA-C, who works with O’Connor, explained that the physician and PA aim to ensure that safety measures reviewed by the nursing staff are reinforced to the patient and his or her family during team rounds each morning when the physician and PA examine the patient and develop a plan for the day. The PA communicates the Morse Falls Score to the team during the presentation of vital signs and clinical events overnight, and the score is used to guide the conversation about patient safety with the patient and family.
The team also consults with the pharmacist to make sure that high-risk medications are avoided or their risks are minimized. The team may also consult with the psychiatry and physical therapy departments to address fall risk factors associated with acute impairments in cognition and mobility.
The pharmacist typically conducts an independent review of medications prescribed to patients who have been identified as high risk by the team and then makes recommendations to the team about changes in drug regimens that might be needed to curb the risk of falls.
Important safety measures include:
Overall, nine patients in the unit where the program was implemented were identified as being at high risk of a fall. At the time of the ONS meeting 6 months after the start of the program, no patient had sustained a fall.
O’Connor pointed out that although the sample size in the study was small, her group hopes that “our intraprofessional communication model” will be adopted by other teams on the current unit and extended to other inpatient oncology units.
“We believe that direct communication between interdisciplinary caregivers influences the patient’s understanding and compliance with the established care plan to prevent injuries from falls,” she said. “In addition, integrating a discussion of fall risk and a plan for high-risk patients during medical rounds with various disciplines may be beneficial because it introduces the potential for a wider range of perspectives and interventions. Daily discussion of patient safety goals by team members holds promise for a simple but effective model to decrease negative outcomes for our patients.”
To sign up for our newsletter or print publications, please enter your contact information below.
