The outpatient RT introduces its own distinctive fall risk factors: treatment often causes fatigue and deconditioning, long clinic walks, the effects of medications, changes in mobility, and cognitive changes. A standardized, easy-to-use workflow integrated into the RT path minimizes risk and facilitates throughput.

Standard workflow

1) Consult / CT simulation (Day 0–3)

  • Screen: TUG + orthostatics; if positive, add High Fall-Risk flag in the EHR.

  • Med review: scan for FRIDs (Beers/STEADI).

  • Plan: escort if needed; gait belt available; schedule rechecks at week 2 and week 6.

  • Educate: give patient/caregiver fall handouts (EN/ES).

  • Document: TUG time, orthostatics, education language, and SBAR handoff in EHR.
    Nurse-led TUG screening is feasible within RT workflows and supports timely rehab referral. Oncology Nursing SocietyOncology Nursing News

2) First 2–3 weeks of RT (fatigue window)

  • Recheck: TUG/orthostatics at week 2; reassess symptoms/FRIDs.

  • If worse: escalate to prescriber/pharmacy; consider PT/OT referral.

  • Detail teach-back and update the plan.
    Ambulatory oncology bundles with rechecks and huddles have reduced fall rates in QI projects. PMC

3) Ongoing daily treatments

  • Front desk/MAs/RTT: mobility aid brought confirmed; EHR flag confirmed; escort prompted for flagged patients.

  • Transport: prioritize patients with TUG ≥12 s or orthostatic symptoms; closed-loop handoffs.

  • All staff: report near-falls and hazards; discuss issues in weekly huddles via RO-ILS. ASTRO+1

4) Sedation/contrast days (if applicable)

  • Pre-book escort; reconfirm NPO/dehydration risks.

  • Quicker way to vault and chair-with-arms prepared post-procedure.

  • Post-sedation recheck (symptoms, orthostatics) before discharge.

Take 5

Environment Sweep (Once Per Area Per Shift)

  • Chairs with arms at check-in, changing rooms, near vaults.
  • Wayfinding & Distance Clear, high-contrast signage; minimize detours. Ensure handrails on long halls.
  • Floors & Cords Remove trip hazards, coil and tape cords along walls. Non-slip mats in changing areas.
  • Lighting & Glare Brighten dim zones; add nightlight equivalents in restrooms. Cut glare.
  • IV pole & device parking defined “docking” zones; keep treatment paths clear.
  • Designated TUG Area-chairs with arms, 10-ft mark in a safe, clear area. (Clinic hazards mirror the common fall hazards addressed in national guidance; adapt home-safety principles to the clinic.)

Roles & Handoffs (Who Does What)

  • Nursing staff: Perform/verify TUG + orthostatics; place High Fall-Risk flag; start bundle. SBAR to MAs/RTT/front desk. Ensure teach-back (preferably in the patient's language).
  • RT Therapists (RTT): Confirm flag before treatment. Cue escort. Place the gait belt as needed. Note concerns RN.
  • Front desk/MAs: Apply scheduling flag. Ask if the patient uses a cane, walker, etc. Alert RN/RTT if the patient reports dizziness or a recent fall.
  • Transport: Assess and escort flagged patients. Confirm destination and handoff back to RTT/RN.
  • All staff: Input falls/near-falls/unsafe conditions into RO-ILS for learning and track results.