Patient Fall Risk Assessment

This checklist can be used as a tool to assess the risk of falling, especially for elderly patients. It takes into account the patientâ€™s fall history, current medication, strength mesures etc., in order to minimise the risk of injury.

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Patient Fall Risk Assessment

Age

Previous Falls

Medication

Vision

Peripheral Sensation

Strength/Reaction

Completion

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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Patient Fall Risk Assessment

This checklist can be used as a tool to assess the risk of falling, especially for elderly patients. It takes into account the patientâ€™s fall history, current medication, strength mesures etc., in order to minimise the risk of injury.

1. Is the patient older than 60?

1. Have there been one or more falls in the last few years?

1. Is the patient currently on four or more pills/medication (excluding vitamins)?

2. Is the patient on any psychotropic medication?

1. Has the patient been reviewed for glaucoma, cataracts, and appropriateness of spectacles?

2. Was a low contrast visual acuity test performed?

1. Checked for diabetes?

2. Was a tactile sensitivity test (check if unable to feel 2 out of 3 trials) performed?

1. Sit to stand test (not able to complete in 12 seconds) performed?

2. Near tandem stand test (Not able to stand for more than 10 secs) performed?

3. Alternate step test (not able to finish in 10 seconds) performed?

1. Rate the fall risk probability

2. Do you have any further recommendations?