The following article features coverage from ONS Bridge 2020. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

 

Planned provision of patient assistance in using the toilet approximately every 4 hours resulted in a nearly 60% reduction in the number of falls on an oncology unit, according to results of a study presented at the Oncology Nursing Society (ONS) Bridge, a virtual conference.

Hospitalized patients with cancer often have multiple risk factors for falls, including older age, cancer-specific characteristics, and receipt of certain types of drug therapy. These patients may also receive aggressive hydration, which is associated with an increased frequency of urination. Furthermore, patients with cancer are at increased risk of injury from a fall.

Following the occurrence of a high number of falls on an oncology unit at the University of California Los Angeles (UCLA) Health Santa Monica, Santa Monica, California, during fiscal year 2018, and the recognition that many of these falls occurred when patients were attempting to use the toilet, as well as findings from a survey that staff provided assistance with using the toilet only upon patient request, a pilot program was initiated in which proactively planned patient assistance with voiding was provided.  

Specifically, patients were taken to the toilet by a nurse or a nurse aide 6 times daily at the following times: 9:00; 13:00, 17:00, 21:00; 24:00; and 5:00. A sign designating participation in the “Time Voiding Rounds” was placed on the door to the patient’s room, and both patients and nurses were educated on physiological factors associated with increased voiding, as well as the risk factors associated with falls. In addition, the patient was kept within arms’ reach while assistance was provided to further decrease this risk, and equipment to assist with mobility was used, if deemed necessary.


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A key finding was that a comparison of the number of falls occurring on the oncology unit during fiscal year 2018 with those occurring during fiscal year 2019, when this pilot program was implemented, showed a decrease from 27 to 10 falls overall, along with a decrease in the number of falls with injury, from 10 to 4.

Of note, during fiscal year 2020, the number of falls occurring on the oncology unit increased compared with fiscal year 2019.

In offering a potential explanation for this finding, the authors, Maria Ortega de Vargas, RN, BSN, OCN, and Amanda K. McKaig, RN, BSN, of UCLA Health Santa Monica stated that “staff turnover and changes in patient acuity may have contributed to this increase.”

They further noted that “to ensure performance excellence and sustainability, patients and staff have been re-educated on the importance of timed voiding, intentional rounding, use of scripted language, and chain of command processes when patients refuse assistance or fall prevention measures.”

Reference

Ortega de Vargas M, McKaig AK. Implementing a timed voiding program in an oncology unit. Presented at: ONS Bridge; September 8-17, 2020. Accessed September 14, 2020. https://ons.confex.com/ons/2020/cp/eposter.cgi?eposterid=1029