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Johns Hopkins Hospital Fall Assessment Tool Cheat Sheet by

Johns Hopkins Hospital Fall Assessment Tool
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Fall Risk Factor Category I

Scoring not completed for the following reason (s) (check any that apply):
___ Patient has experi­enced a fall during this hospit­ali­zation
___ Patient has a history of more than one fall within 6 months before admission
___ Patient is deemed a high risk per protocol (e.g. seizures)
___ Patient has a lack of unders­tanding of one’s physical and cognitive limita­tions

Fall Risk Factor Category 2

For those patients who are not in the above category, complete the following risk assessment tool and calculate fall risk score. If no box is checked, the score for the category is 0.

Fall History

pts (select one)
___ One fall within 6 months before admission (5 points)
___ No falls (0 points)

Elimin­ation, Bowel and Bladder

pts (select only one)
___ No incont­inence, urgency, or frequency (0 points)
___ Incont­inence (2 points)
___ Urgency or frequency (2 points)
___ Urgency/ frequency & incont­inence (4 points)

Medica­tions:

pts (select one)
___ On 1 high fall risk drug (3 points)
___ On 2 or more high fall risk drugs (5 points)
___ Sedation procedure within past 24 hours (7 points)
Includes PCA/ opiates, anti-c­onv­uls­ants, anti-h­ype­rte­nsives, diuretics, hypnotics, laxatives, sedatives, and psycho­tropics
 

Patient Care Equipment:

pts (select one)
___ One present (1 point)
___ Two present (2 points)
___ Three or more present (3 points)
Any equipment that tethers patient, e.g. IV infusion, chest tube, indwelling catheters, SCDs, etc.

Mobility

pts (Multiple select, choose all that may apply and add points together)
___ Requires assistance or superv­ision for mobility, transfer, or ambulation (2 points)
___ Unsteady gait (2 points)
___ A visual or auditory impairment affecting mobility (2 points)

Cognition

pts (Multiple select, choose all that apply and add points together)
___ Altered awareness of immediate physical enviro­nment (1 point)
___ Impuls­ivity/ poor safety judgment (2 points)
___ Short term memory loss (2 points)

Total points scored

___ Total
Moderate risk = 5-12 total points. High risk = 12 points or greater

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