Luann Capone, MSN, MPA, RN, GNP-BC, has spent the last decade researching falls in cancer patients and developing a falls risk tool for that patient population.
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“Falls prevention in hospitalized patients is an important nursing quality indicator,” says Capone, a nurse practitioner in Cleveland Clinic’s Connected Care program. “Current falls risk tools do not address cancer and cancer treatment related fall risk factors. We conducted research to address that gap in knowledge.”
Researching falls risk and prevention
Capone began her research while enrolled in the nurse practitioner program at Case Western Reserve University in Cleveland, Ohio in 2004. “At the time I was director of nursing quality at Cleveland Clinic’s main campus, and I was inundated with data on falls and falls prevention,” she says. “I noticed a trend that more cancer patients seemed to fall. And when they fell, they seem to get harmed more often.” Capone partnered with Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, to research falls in cancer patients. Dr. Albert is the associate CNO, Office of Research and Innovation.
During the first phase of the study, published in the Journal of Nursing Care Quality (July/September 2010), Capone and Dr. Albert compared data on 158 hospitalized cancer patients who fell with adult medical/surgical hospitalized patients who fell. In the second phase, they determined predictors of fall events in hospitalized patients with cancer and developed a scoring system to predict fall events. Those results were published in the Oncology Nursing Forum (September 2012). Capone then used that data to create the Cleveland Clinic Capone Albert (CC-CA) Falls Risk Assessment tool.
Creating a predictive tool
The original identified seven predictors of falls in hospitalized patients with cancer as low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medications use and blood product use. In 2013, other Cleveland Clinic nurse researchers conducted validation of the CC-CA Falls Risk Assessment tool. The tool was compared to the Morse Fall Risk tool and was found to predict falls more accurately in patients hospitalized for cancer or palliative care. The nurse researchers discovered that pain level—one of the original findings—was insignificant and therefore it was removed from the tool.
The fall risk tool assigns points to each of the six indicators based on answers to a series of related questions. For example, the presence of metastasis equals 69 points. The maximum number of possible points is 400, with fall risks increasing the higher the total. For instance, patients who earn the maximum points are at a 93.8 percent fall risk, while those with 284 points are at a 50 percent fall risk.
The Cleveland Clinic Capone Albert Falls Risk Assessment tool has been copyrighted and requested by several healthcare organizations. Capone and Albert have worked with Cleveland Clinic Innovations to bring the tool to market. The tool is now available at the Innovations website for healthcare organizations to purchase and use in preventing falls in this vulnerable population and assist in reducing falls in hospitalized patients with cancer and in palliative care.
Photo @ Russell Lee Photography