Prior to the program, patients with hematologic cancers walked an average of 136 steps in a 24-hour period. One month after the program began, that total increased to an average of 1,018 steps per day.
Patients being treated for hematologic malignancies at City of Hope National Medical Center in Duarte, California took “dramatically” more steps each day after a walking program was implemented there, according to study results presented at the recent 2021 Oncology Nursing Society (ONS) Annual Congress.
City of Hope nurses recognized that patients did not walk as much during their hospitalization. The number of falls also increased and documentation of ambulation in electronic medical records decreased, prompting presenter Kimberly Mercado and her colleagues to create and implement a walking program for patients to increase ambulation and decrease falls.
“We really wanted to give them a program that would help them to get motivated to exercise on the unit and kind of get out of their rooms and keep up their stamina while they're receiving this treatment. Because as we all know, these treatments can be quite debilitating as in especially during COVID,” Mercado said during her poster presentation. “When the visitor policies don't allow for very many visitors, we wanted to make sure they had something to look forward to during their day and kind of get out and move.”
Mercado also noted that a walking program could potentially be beneficial to patients suffering from cancer-related fatigue, as exercise had been previously shown to improve this side effect.
To kick off the program, Mercado and her team created a brochure that explained the program to newly admitted patients and hung motivational posters throughout the unit to help keep patients interested in walking.
Foot-shaped charms were also given out as incentives that patients earned as they achieved each milestone. “Anytime a patient walked a lap, they could get a foot charm and hang it on their IV pole on a little chain to kind of remind them how much they've walked,” Mercado explained, “And it became nice for them to collect and understand just how well they were doing.”
“Another incentive we gave was a reusable City of Hope mask that if anybody walked to 5K (3.1 miles) while they were on the unit, they would be given this to take home with them,” Mercado added.
A staff education component was implemented through emails, flyers, and in meetings, with the goal of explaining the program and offering tips how to encourage patients to participate.
Before the program, patients walked an average of 136 steps in a 24-hour period. A few weeks after implementation, that number jumped to an average of 847 steps, and further increased to an average 1,018 steps per day at the end of one month.
Although fall data is still being collected, the number of patient falls decreased from six in Q1 of 2020 to four in Q1 of 2021. Additionally, the number of falls with injury was zero, compared to one in 2020. To Mercado and her colleagues, this data, coupled with the dramatic increase in daily steps, signaled a success. “Patients seem to really take to it and enjoy it as well,” she noted.
“As we go along, we obviously want to keep doing this program on our floor. Maybe it could even go house-wide at some time,” she said.
In addition to evaluating fall data, going forward, Mercado concluded that she and her colleagues plan to gather patient feedback to further improve upon the walking program and add additional incentives such as challenge coins, pins, and patches for completing milestones such as distances of 10 kilometers (6.2 miles), a half marathon (13.1 miles) or even marathons (26.2 miles).
“If you can walk a marathon while you're getting cancer treatment, that's incredible,” Mercado said.
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