The implementation of a falls observational tool in a palliative care setting: a mixed methods study
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Background
Falls are a major safety concern in healthcare. Palliative patients are particularly vulnerable due to complex symptoms and rapid physical decline. Standard falls risk assessment tools designed for acute settings rely on static scores and lack efficacy in hospice environments. The Falls Early Warning Score (FEWS) is an observational tool developed to address the specific needs of palliative patients; however, evidence describing its use and impact remains limited.
Aims
To explore staff views regarding the implementation, utility, and benefits of the FEWS tool in a specialist palliative care inpatient unit.
Methods
A mixed-methods study was conducted at a UK hospice. Healthcare professionals using FEWS completed an electronic questionnaire on confidence, practice, and barriers. Findings informed semi-structured, face-to-face interviews. Qualitative data were evaluated using reflexive thematic analysis.
Results
Eleven staff completed the questionnaire and five joined interviews. Three major themes emerged: (1) Education: Staff preferred 1:1 training and dedicated user guides; (2) Location and format: Electronic formats aided data collection, while paper charts offered better bedside accessibility, and (3) Recognised benefits: FEWS prompted safe staffing, highlighted variable patient presentation, and mitigated the emotional and physical impact of falls.
Conclusions
Integrating bespoke falls risk assessment tools into palliative care is feasible and highly acceptable. Customised tools like FEWS empower staff and support dynamic clinical decision-making. Further research is needed to evaluate their clinical efficacy in reducing falls.
KEY MESSAGES
What is already known on this topic
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Falls are one of the most frequently recorded safety incidents in healthcare, and palliative care patients are at a high risk of falling due to fluctuating physical decline and complex symptom burdens.
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Standard falls observational assessment tools are primarily designed for acute hospital settings and lack efficacy in hospice environments because they rely on fixed, static risk scores.
What this study adds
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Bespoke falls observational assessment tools (such as the FEWS chart) are highly acceptable to hospice staff and are perceived to improve falls management by prompting safe staffing levels and highlighting rapid patient deterioration.
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The successful implementation of new clinical tools in palliative care requires continuous, tailored educational support (e.g., 1:1 training and dedicated user guides) and careful consideration of bedside accessibility.
How this study might affect research, practice or policy
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The findings support the evidence base for developing and integrating customised falls management solutions into specialist palliative care clinical practice.
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This study highlights the need for future prospective research to determine the quantitative clinical effectiveness of the FEWS tool in reducing the actual incidence of falls.
