Fall Risk Assessment Tool
Scoring not completed for the following reason(s)
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Complete paralysis, or completely immobilized. Implement basic safety (low fall risk) interventions.
Client has a history of more than one fall within 6 months before admission. Implement high fall risk interventions throughout
hospitalization.
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Client has experienced a fall during this hospitalization. Implement high fall risk interventions throughout hospitalization
Complete the following and calculate Fall Risk Score. If no box is checked, score for the category is (0)
Points
Age
1 pt
60 – 69 years
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2 pts 70 – 79 years
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3 pts  80 years
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Fall History
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5 pts
One fall within 6 months before admission
Elimination: Bowel and Urine
2 pts Incontinence
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3 pts Urgency or frequency
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4 pts Urgency/frequency and incontinence
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Medications: PCA/Opioids, Anti - convulsants, Anti - hypertensives, Diuretics, Hypnotics, Laxatives, Sedatives, Psychotrophics
3 pts On 1 high fall risk drug
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5 pts On 2 or more high fall risk drugs
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7 pts Sedated procedure within past 24 hours
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Client Care Equipment: Anything that tethers the Client, for example, IV, Chest tube, Foley Catheter, SCDs
1 pt
One present
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2 pts Two present
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3 pts 3 or more present
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Mobility (Select all that apply and add points together)
2 pts Requires assistance or supervision for mobility, transfer, or ambulation
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2 pts Unsteady gait
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2 pts Visual or auditory impairment affecting mobility
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Cognition (Select all that apply and add points together)
1 pt
Altered awareness of immediate physical environment
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2 pts Impulsive
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4 pts Lack of understanding of one’s physical and cognitive limitations
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*Moderate risk = 6 - 13
High risk > 13
Total
The Johns Hopkins Hospital © 2006
This tool was created by John Hopkins Hospital. Permission for use has been granted.