Adaption of Action Falls for Palliative Care
Research type
Research Study
Full title
The adaption of the Action Falls Multifactorial falls prevention programme for use in Hospice care
IRAS ID
328210
Contact name
Frances Allen
Contact email
Sponsor organisation
University of Nottingham
Duration of Study in the UK
0 years, 2 months, 14 days
Research summary
Research Summary
Falls are a common and often life changing experience particularly for older people or those with medical conditions. People who fall can be affected in many ways including losing confidence, independence, injury and death.
A programme called Action Falls was developed through the FinCH research trial. It is a system of training staff to assess risk of an individual falling, followed by action planning and management to reduce the risks. The Action Falls programme was shown to be cost-effective and reduced falls by 43% in care homes. Palliative care patients are at a greater risk of injury when they fall, compared to older people. Falls in Hospices are up to four times more common than in care homes.
Patients in palliative care can have similar problems to people in care homes. However, hospice patients also can have specific falls risks such as symptomatic decline, opioid use and brain metastases which mean that the current Action Falls programme may not work as effectively in hospice care settings. In this study we ask: How can the Action Falls multifactorial falls assessment programme be adapted for use within Hospices? This will enable us to write guidelines for adapting the Action Falls programme specifically for use in Hospice care.
We will ask a group of 13 palliative care experts, patients and family members who have experienced palliative care, to look at the Action Falls programme to see which part of Action Falls could be used in hospices. This method is called the RAND/UCLA Appropriateness Method.
This study will highlight important areas for falls prevention within Hospice care to be shared with the Hospice community through forums, presentations and journal papers.
The results will also form the basis of the next research project to develop a new way of assessing and preventing falls in hospices.Summary of Results
Hospices support people with complex life limiting conditions to help control symptoms such as severe pain, and also provide care for them at the end of life. This is called palliative care. The inevitable decline in mobility and independence and the types of medication needed to manage pain for these types of patients, means that falls in hospices are common. Research has shown that falls are a major concern for families of people looked after in hospices, for staff who care for them, and the organisations. Falls can result in serious injuries, reduce independence and confidence and negatively affect end-of-life experience for affected patients and their families. Our previous work on falls prevention in care homes showed that using a specially designed checklist to assess each resident’s risk of falls with suggested actions to minimise the risks, alongside a programme of training and support for staff meant that falls were reduced by 43%. This programme designed to reduce falls in care homes, is called the Action Falls Multifactorial Falls Prevention Programme. In this study we aimed to find out if the programme could be adapted for hospice care as the patients and organisations are very different to care homes. We aimed to take one part of the programme at first, the checklist, to see how and if it could be adapted for the very different hospice setting and complex needs of the hospice patients. The checklist covers six categories of risks; History, Behaviour, Intake, Intrinsic, Mobility and Environment. Each category has several identified risks and suggested actions to minimise the risks.
For the study we used a method to gain knowledge and agreement of what is required to reduce falls risks in palliative care from an expert panel of clinicians, patients and families with lived experience of hospice care. The method we used was called the RAND UCLA consensus method. The expert panel decides what is appropriate and necessary in the falls checklist for hospices through a survey, feedback, focus group and a final survey.
Thirteen expert practitioners took part between September-November 2023. No patients or families with lived experience of hospice care could be recruited. Involving patients and families in research at the end of life is known to be challenging. This is a limitation of the study and will be addressed at the next stage of the research. The expert panel scored the existing checklist’s identified risks and associated actions for appropriateness in the hospice environment, with space for additional comments. The survey results were analysed, and items with big differences in opinion or considered inappropriate were modified or removed. The final checklist was further refined through the focus group and final survey.
A major difference from care homes requiring changes to the checklist, is that the structure of hospice services are more clinical, with daily ward rounds and 24-hour access to doctors, specialist nurses and therapists. This is very different to care homes where residents are referred to the General Practitioner and community nursing teams if they need medical care. The checklist also needed changes because the types of medication used in hospices increase the risks of falls but are necessary to manage pain and so the risks have to be accepted and managed. Actions to manage this include encouraging patients to ask for help before moving, making sure they can reach a call bell, and teaching them how to call for help if they do fall. Care home residents are taught how to get up from the floor if they fall, but most hospice patients are unable to get up by themselves due to the deteriorating nature of their condition. Changes to the list were particularly important in the Intake category. Fluid and food intake targets in the original checklist were considered distressing and not appropriate particularly for patients nearing or at the end of life. Changes focussed on optimising comfort and pleasure in eating and drinking. Patients in hospices often do not recognise that they are deteriorating and still try to maintain their independence putting them at risk of falls if they are too weak to safely do the things they want to do. The checklist was changed to reflect this and make sure that patients are assessed, and helped to do as much as they can within their capability at that moment in time, as fatigue can vary on a day by day and hour by hour basis. Continence management is also important as many falls are reported to be related to patients hurrying to get to the toilet and not wanting to ask for help. Reassuring them that they should call for help and having regular toileting regimes are some example of actions to help reduce this risk.
The study shows that adaptation of the Action Falls Checklist is feasible and necessary for the hospice setting. An adapted checklist has been produced ready for the next stage of the study. This will be to adapt the rest of the Action Falls Multifactorial Falls Prevention Programme for the hospice setting and to test how the adapted checklist and programme work in real life settings.
The checklist is a very important part of this plan as the assessments of the risks and small, easily implemented actions, can help lessen the risks associated with supporting hospice patients to be as active as possible while improving comfort and quality of life.REC name
HSC REC B
REC reference
23/NI/0107
Date of REC Opinion
3 Aug 2023
REC opinion
Further Information Favourable Opinion