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Introduction: Patients receiving cancer treatment are at high risk for falls. No current guidelines or standards of care exist for assessment and prevention of outpatient oncology falls. This quality improvement project's purpose was to 1) describe and evaluate outpatient oncology falls data to determine root cause(s), and develop, implement, and evaluate intervention strategies for future policy refinement, and 2) compare fall rates pre/post implementation of a system-wide Ambulatory Fall Risk Bundle. Methods: Retrospective data were used to describe and categorize fall incidence for the University of Kansas Cancer Center over 12 months. Further analyses were conducted to describe fall rates per 10,000 kept appointments pre/post implementation of an Ambulatory Fall Risk Bundle protocol. Semi-structured interviews were conducted with medical assistants and nurse managers to evaluate the initiative's impact, staff satisfaction, and recommendations for refinement. Results: The initial 12-month assessment yielded 58 patient falls retained for further analyses. Most patients were receiving chemotherapy (46, 79%). Common contributing symptoms included dizziness/ faintness and weakness (25, 43%). Tripping/falling over a hazard (12, 24%) and falls during transfer (10, 5.8%) also were cited. Subsequent analyses of fall rates indicated no change. Recommendations resulting from the qualitative interviews included: orthostatic vital sign protocol implementation, redesign of the electronic medical record fall risk alert, stakeholder involvement in protocol development, staff training, and related patient education strategies, and the procurement of additional assistive devices/equipment. Conclusions: System-related policy and culture change, investment in physical and human resource enhancements, and evidence-based protocols are needed to improve outpatient oncology fall rates.
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INTRODUCTION: Emerging adults (ages 18 to 25) are more likely to use e-cigarettes compared to other age groups, but little is known about their risk and protective factors. A next step to understanding e-cigarette use among emerging adults may involve examining how transition-to-adulthood themes are associated with e-cigarette use. It may also be important to know which specific transitions, and how the accumulated number of role transitions experienced in emerging adulthood, are associated with e-cigarette use. METHODS: Emerging adults completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and e-cigarette use. Logistic regression models examined the associations between transition-to-adulthood themes and e-cigarette use. Separate logistic regression models explored the association between individual role transitions, as well as the accumulated number of role transitions experienced, and e-cigarette use, controlling for age, gender, and ethnicity. RESULTS: Among the participants (n = 555), 21% were male, the average age was 22, 45% reported lifetime, and 12% reported past-month, e-cigarette use. Participants who felt emerging adulthood was a time of experimentation/possibility were more likely to report e-cigarette use. Several role transitions were found to be associated with e-cigarette use such as loss of a job, dating someone new, and experiencing a breakup. The relationship between the accumulated number of role transitions and e-cigarette use was curvilinear. CONCLUSION: Findings from this pilot study can be a point of departure for future studies looking to understand the risk and protective factors of e-cigarettes among emerging adults.
