Background Falls are the leading cause of hospitalisation and death due to injuries in Australia. Amongst hospitalised patients, falls are the most common safety incident and cause substantial concern among staff and families. Current Best Practice Guidelines for preventing falls in older people in Australian hospitals do not specifically address falls in palliative care settings. Identifying and managing falls risk in palliative care is crucial for maintaining healthcare standards and ensuring patient safety and quality of life.

Objectives The primary aim of this study was to determine the incidence of falls in an inpatient palliative care unit over a one-year period. Secondary aims included determining the outcomes of falls, characteristics of patients with falls, and the fall prevention interventions utilised.

Methods This retrospective cohort study examined falls by palliative care patients admitted to a 40 bed metropolitan palliative care inpatient unit (IPU) over a 12-month period. Falls were identified using the online incident reporting system and patient characteristics, falls risk assessment and prevention measures was obtained through the electronic patient records.

Results A total of 525 individual patients were admitted to the IPU for 613 episodes of care, representing 10,536 bed days. There were 61 falls by 51 individual patients, yielding an incidence of 9.7 and the rate of falls was 5.8 falls per 1000 bed days for all admitted patients.

Falls occurred throughout the day, with more falls between midnight and 08:00. Most falls (93%) were unwitnessed. Half of the falls resulted in no injury, while the most common injuries were skin tears/abrasions and haematomas. Serious injuries such as fractures occurred in 1.6% of falls. Of the patients who fell, 41% died within one week post-fall.

Falls risk assessment was completed for 97% of patients at the time of the fall. Fall mitigation strategies were in place for 93% of falls, including bed rails, alarms, increased observation, education, assistance with toileting, and grip socks. Six falls (10%) involved patient refusal of fall mitigation strategies.

Discussion The fall rate in the IPU was 5.8 falls per 1000 bed days, the lowest reported for inpatient palliative care units. Compared to similar studies, this study had a large sample size and provided comprehensive data on falls incidence, prevalence, and rates. Most falls did not result in serious injury, and falls prevention strategies were widely implemented. However, the refusal of mitigation measures by some patients highlights the need for interventions that respect patient autonomy and dignity.

Conclusion This study provides valuable insights into falls in inpatient palliative care units, reporting an incidence of 9.7% and a rate of 5.8 falls per 1000 bed days. Falls prevention strategies must balance patient autonomy with safety and quality of life. Further research is needed to assess the effectiveness of interventions and gather patient and staff perspectives on falls prevention in palliative care settings.