Reducing falls in the outpatient oncology clinics.
Authors: Kam Winnie , Mattia Angela , Scrimenti Lara , Rodriguez German , Rahat Camilita , Babaran Catherine , Khunasvili Nino , De Boer Colleen , Guzman Jose , Mayer Sebastian Alexander , Garcia Christine Ann 
Published: September 2021

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Background: Patients with cancer are at particularly high risk for falls and unfortunately may suffer worse outcomes with falls. Patients with cancer are at increased risk for fractures due to bony metastases, and worse subsequent bleeding due to thrombocytopenia from disease or from prophylaxis or treatment for deep vein thromboses. In 2020, there were 10 falls among patients with cancer in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinics, with a fall rate of 0.31 falls per 1000 patient visit. In 2019, there were 14 falls (0.39 falls per 1000 patient visits).The aim of this project is to reduce the total number of falls and overall fall rate by 50% in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinic areas by December 30, 2021. Methods: In Plan-Do-Study-Act (PDSA) cycle in February 2021, we identified key stakeholders (nurses, medical assistants, nurse navigators, and clinic managers) in NYP/Weill Cornell oncology outpatient areas. We engaged key stakeholders in a series of interactive conferences to introduce and implement quality improvement tools (root cause analysis and process mapping) with outpatient teams to identify risk factors for patients who fell in NYP/Weill Cornell oncology outpatient areas from 01/2020-12/2021. A standardized post-fall huddle process was implemented, and prior falls were reviewed using this process. Interventions were based on these identified risk factors to prevent falls in the outpatient clinic areas. In the second PDSA cycle which began April 1, 2021, a new handoff process was initiated in the outpatient clinic setting. Prior to the end of the shift, the charge nurse cross references the “G Drive list” with patient list for the following day and identifies patients with previous falls or those identified by nurses as being high risk for falls. This list is located in a commonly used, HIPAA compliant file location, which was already part of the normal scheduling workflow. These patients are then discussed in the daily huddle to create awareness by all staff and provide “handoff” between visits which by design cannot happen nurse to nurse with each visit. The team has been reviewing the list monthly to develop a sustainability plan. Results: Since the completion of the interactive QI conferences in PDSA cycle 1, there have zero additional falls in the oncology outpatient clinic areas. Continuing on into PDSA cycle 2 with the new handoff process, there have not been any additional falls. Conclusions: This project demonstrates an effective QI intervention to reduce falls in the outpatient oncology areas and prevent injuries in this vulnerable population. This multidisciplinary approach to identifying root causes for falls and reviewing our processes for monitoring patients in our infusion areas ultimately has led to significant reduction in falls. It has also empowered key stakeholders in our oncology clinics with QI tools to address other areas for improvement.