Background Multiple factors contribute to inpatient falls. Spinal metastases occur in 3–5% of all cancer patients, with incidence up to 19% in breast, prostate and lung cancer patients. Median survival following diagnosis of metastatic spinal cord compression (MSCC) is reported to be 2–3 months. Back pain occurs in 95% of these patients with second most common symptom of limb weakness. We set out to review and strengthen the assessment of hospice inpatients with lower limb neurological deficits and identify if this was a contributing factor to falls.
Methods Retrospective case-note review of patients admitted over a 4-month period to a hospice inpatient unit (IPU) to identify patients who have a neurological assessment as part of their admission and following an inpatient fall. Data was collected in 2021 and repeated in 2022.
Results 30% (15/47) patients admitted in 2021 had known spinal cord, nerve root or peripheral nerve involvement. 25% patients were identified to have a neurological deficit on admission to the IPU. 28% patients had a lower limb neurological deficit on examination during admission. 7/10 falls incidents involved a patient with a background of known neurological deficit with 2/10 falls incidents identifying neurological deficit as a contributing factor. The percentage of falls incidents reports with neurological assessments improved from 0% in 2021 to 50% in 2022.
Conclusion Hospice patients are more likely to present with widespread disease burden including involvement of the spinal cord with neurological deficit to the lower limbs increasing the risk of inpatient falls. This review has highlighted the importance of a neurological assessment in patients who have inpatient falls in the hospice setting. Increased awareness amongst staff on importance of neurological assessment and effective documentation on falls incidents is an important role in interdisciplinary approach to falls prevention.
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