Adaption of the Action Falls Multifactorial Checklist for Inpatient Palliative Care (AAFPC): A RAND-UCLA Consensus Study

Abstract

Background

Falls are a significant challenge in inpatient hospices, with serious consequences including injury, loss of confidence, prolonged admissions, and reduced quality of life. The Action Falls Programme, a multifactorial falls prevention intervention, has proven effective in UK care homes. However, hospice patients present distinct risks related to their complex, palliative care needs, necessitating adaptation of the checklist for this setting.

Objective

To adapt and refine the Action Falls checklist for use in inpatient hospices by achieving expert consensus on the relevance and appropriateness of individual risk and action items.

Methods

A modified RAND/UCLA Appropriateness Method was used across 3 iterative rounds involving 14 hospice professionals from 4 UK hospices. Round 1 involved rating risk and action items on a 9-point Likert scale. Items with low agreement were taken forward to a facilitated online focus group for discussion and refinement. A final survey assessed appropriateness and necessity of the revised checklist.

Results

Consensus was achieved on a revised hospice-specific checklist comprising 21 risk items and 34 actions, covering 6 domains: History, Behaviour, Intake, Intrinsic, Mobility, and Environment. Key adaptations included shortening the timeframe for fall history, removing redundant references to general practitioners and external referrals, and shifting emphasis from nutrition to hydration. Environmental risks like flooring and temperature were removed due to limited relevance. Patient-centred concerns, including fatigue, continence, and fluctuating mobility, informed the revised actions.

Conclusion

The Action Falls checklist can be adapted for inpatient hospice settings, reflecting the unique needs and care context of this population. The adapted checklist achieved expert consensus and is now suitable for feasibility testing. Further research is needed to evaluate its effectiveness in reducing falls within hospices.