SAN ANTONIO, Tex.—High-risk medications can increase falls in patients undergoing treatment for malignant hematology, but implementing risk-specific fall prevention strategies can ameliorate the effects of the drugs, according to an oral presentation at the ONS 41st Annual Congress.1

At the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, part of the responsibilities of the nursing shared governance committee is to identify trends in patient care, explained Joel Stettler, BSN, RN, OCN®. The nurses and oncology technicians on this 24-bed inpatient malignant hematology unit worked with its Quality Improvement Committee to determine what increased the risks for falls in this patient population.

Falls and fall-related risk of injury are a major concern for patients undergoing treatment for malignant hematology. These patients are at increased risk due to prolonged effects from both their disease and its treatment. The risk of falls is highest toward the end of treatment as physical functioning is impaired, and the administration of multiple treatments causes physiological changes.

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Furthermore, the Morse Fall Scale does not reflect the potential complications from medications used to alleviate treatment-related side effects to increase fall risk.

The committee identified furosemide (Lasix), lorazepam (Ativan), and first-time sleep aids as medications correlated with increased fall risk. “The Quality Improvement Committee determined that patients receiving high-risk medications would be on bed or chair alarms for the duration of the drug effect,” Stettler said.

In addition to use of devices such as hip protectors and protective capps, communication between the nurse and the oncology technician is emphasized as an essential component. Nurses communicate medication administration to oncology technicians who know to assist patients with walking and ambulation for 15 to 20 minutes after medication administration.

These strategies resulted in a 60% decrease in falls in the 2 quarters following implementation of these strategies. Next steps are to expand the scope of these interventions to other potential fall risk factors, such as fevers, for this patient population.


1. Stettler J, Hoffman M. A nurse driven strategy to reduce falls in the inpatient malignant hematology population. Oral presentation at: Oncology Nursing Society 41st Annual Congress; April 29-May 1, 2016; San Antonio, TX.