A Fall Prevention Protocol for Home Hospice Patients

Hospice patients are at a greater risk of falls than community-dwelling geriatric populations due to the nature of terminal illness. Although the necessity of developing a fall risk assessment and fall prevention protocol for home hospice patients has been discussed, an assessment protocol for home hospice patients does not exist. Hospice providers attempt to use fall risk assessment tools that were developed for nursing home patients, leading to frustration, as these are different patient populations. Fall prevention is complex and different in the home care setting due to the heterogeneity of the home environment. Therefore, inclusion of fall risk factors encountered in general home settings is imperative and must be paired with the fall prevention protocol. Fall risk assessment for nursing care facilities is often used to assess home hospice patients' fall risks. However, inappropriate items make the assessment tool less relevant to the hospice population. Evidence-based practice in hospice is needed to increase the safety in hospice. Research has been limited in hospice due to ethical concerns, distress in families and patients, and a lack of research experience among hospice providers. Electronic health record systems have recently been introduced in most home hospice companies. Ways to measure quality of patient safety care by measuring the number of falls need to be developed. Consequences of falls in hospice include decrease in quality of life (QOL), increase in medical cost, and negative effect on the goal of hospice care. QOL in end-of-life care can be severely affected by the occurrence of a fall, which may even preclude the possibility of receiving home hospice care if a patient becomes institutionalized due to the injury. Furthermore, medical costs following a fall-related injury can result in significant financial impact. The purpose of this project was to develop an evidence-based fall risk assessment and prevention protocol for home hospice patients to enhance patient safety while maintaining the primary goal of hospice. Objectives of the project included: (1) create a fall risk assessment and fall prevention protocol for home hospice patients; (2) present the new fall risk assessment and prevention protocol to Inspiration Hospice team; and (3) disseminate the project to raise awareness of the consequences of falls in the hospice population. Implementation steps were: (1) observe and interview interdisciplinary hospice team members and contact local hospice companies for existing fall protocol forms; (2) present the new fall risk assessment and prevention protocol to Inspiration Hospice and Solstice Palliative and Hospice Care, modifying based on feedback from the hospice team and content experts; and (3) complete submission to the Journal of Hospice and Palliative Care Nursing. Evidence-based fall risk assessment and fall prevention protocol for hospice patients living in a home care setting will preserve the integrity of the main purpose of hospice care, enhance home hospice patient safety, improve end-of-life QOL, and reduce the cost of care from falls.