An algorithm can help nurses reduce falls in hematology/oncology inpatients, according to a presentation at the 48th Annual Oncology Nursing Society (ONS) Congress.

A team of nurses reviewed inpatient falls with injury on a 30-bed hematology/oncology/bone marrow transplant unit. The review revealed that many inpatient falls — 64 of 127 falls — occurred when patients were moving to the bathroom without assistance. These falls occurred despite use of the Morse Fall Scale and standard fall precautions.

The nurses initiated a quality improvement project to decrease rates of falls, including falls with injury. They implemented a risk factor algorithm designed to evaluate a patient’s fall risk. The algorithm included specific oncology risk factors that were not captured by the Morse Fall Scale. The algorithm included 2 sets of criteria.

Continue Reading

Criteria in the “red” category were the following:

  • Low hematocrit (≤21) and/or low platelets (<10)
  • Orthostasis, hypotension (change by 20 mm Hg)
  • Confused mental state.

Criteria in the “yellow” category were the following:

  • Fever (temperature ≥100.4)
  • Diarrhea, vomiting, diuretics
  • Reported dizziness or prior falls during this hospital stay.

A patient who achieved 1 of the red criteria or 2 or more of the yellow criteria would receive a stand-by assist.

The implementation involved the nurses assessing their patients’ risk of falling based on the stand-by assist algorithm. This was done at shift change, which occurred at 7 am and 7 pm. If the algorithm flagged a patient as needing help with ambulation, the nurses were to notify the patient of their ambulation needs and risk factors and also put appropriate signs outside their room.

Although this study is ongoing, the nurses noted a 50% reduction in falls with injury on the 30-bed unit, compared to the previous year. A key component of the program’s success was a daily safety huddle that involved patient care assistants and unit coordinators, as well as the patients’ perceptions of their risk factors for falling.

The nurses concluded that the algorithm was useful in reducing falls and falls with injury in this patient population, which could improve patient outcomes and reduce readmission costs and length of stay.


Miller D, Toomey E. Decreasing rates of inpatient falls with injury: Implementing an individualizable fall prevention algorithm for hematology/oncology patients. Oral presentation at: 48th Annual ONS Congress; April 26-30, 2023; San Antonio, TX.

This article originally appeared on Oncology Nurse Advisor