8 February 2019

Patient’s Fall Risk Assessment


One of the common risk to safety of patients in hospital is the risk of fall. Several epidemiological studies has found that on an average 3 to 5 patient fall incidence occur in every 1000 bed-days. It is also estimated that a third of fall results into injuries which could be severe such as fracture. Due to the widespread prevalence and resulting harm, prevention of patient fall is included as one of the International Patient Safety Goals (IPSG) of JCI standards for hospitals.

The first step to prevention of fall is identifying patient who is at a risk of fall. Most accreditation bodies, including NABH and JCI expects hospital to undertake a fall risk assessment of all admitted patient and take preventive measures for those who are at a higher risk of fall.

The table below describes the points that should be used for assessing risk of fall, and classifies features into very high, high, moderate and low risk categories.



FEATURES
RISK LEVELS
Very High Risk
High Risk
Moderate Risk
Low Risk

Age

> 75 years


70 to 75 Years

65 to 69 Years

60 to 64 years
Fall History
History of two or more falls in last six months 

OR

History of fall during current admission

History of one fall in last six months
History of one fall in last one year
 -
Fall risk medications*
Patient on more than two fall risk medication
Patient on two fall risk medications
Patient on one fall risk medications
Patient occasionally takes a fall risk medication

Loco-motor ability
Patient entirely dependent on others for moving from one place to another
Visual or auditory impairments that affects independent movement of patient

Requires another person’s support or crutches for walking
Patient needs a walking stick
Cognitive ability
-
Impaired cognition

Impulsiveness
Altered awareness



Equipment attachment**

Three or more equipment attached to patient’s body

Two equipment attached to patient’s body
One equipment attached to patient’s body
Bowel and Urine Function


Incontinence with urgency/frequency
Incontinence or urgency/frequency
* Fall risk medications include sedatives, psychotropic, opiates, anti-convulsants, diuretics, anti-hypertensive and hypnotics
** Such equipment include things like chest tubes, indwelling catheter, IV infusion etc.

Following points should be considered to determine the risk level.
      ·         Presence of even one feature is sufficient to classify the patient into the risk category, to which the feature belong
      ·         If a patient presents two or more features of a category, the risk level of the patient should be raised to the next higher level. For example, if a patient is of 67 years of age and is taking one fall risk medication, the patient should be categorized as ‘High Risk’.
      ·         If a patient shows features from different risk levels, the patient should be considered in the risk level which is the highest among all. For example, if a patient shows one feature of ‘Low Risk’, one of ‘Moderate Risk’ the patient should be considered as ‘Moderate Risk’
      ·         Patients who do not show any of the features should be considered as ‘no risk’. Although, even such patient can have a fall, the chance are very low and hence for all practical purpose, no special fall prevention measures are required in such patients.



Suggested post: 

Safe transfer of unstable patient from hospital