Date of Initial Assessment: Unit

:
**Select only one indicator for each category.
Mobility Score Score
(0) Ambulates with no gait disturbance
(1) Ambulates or transfers with assistive devices
(1) Ambulates with unsteady gait and no assistance
(0) Unable to ambulate or transfer
Mentation Score Score
(0) Alert, oriented X 3
(1) Periodic confusion
(1) Confusion at all times
(0) Comatose / unresponsive
Elimination Score Score
(0) Independent in elimination
(1) Independent, with frequency or diarrhea
(1) Needs assistance with toileting
(1) Incontinence
Prior Fall History (within past 6 months) Score Score
(1) Yes – Before admission (Home or previous inpatient care)
(2) Yes – During this admission
(0) No
(0) Unknown
Current Medications Score Score
(1) A score of 1 is given if the patient is on 1 or more of the following
medications: Anti-convulsants / sedatives or psychotropics / hypnotics
(consider all medication side effects and role in fall risk.)
Score Score
Total Score:
Completed By: (signature / designation)
Date: (yyyy/mon/dd)
Total Score
Score of 3 or more: Patient is at risk for falls and fall prevention interventions should be implemented – see reverse side
Schmid Fall Risk Assessment Tool – Acute Care
103511 © Alberta Health Services, (2009/06) Page 1 of 2
yyyy/mon/dd
To be completed on all patients upon admission, post-fall, and/or when
the patient’s status changes.
Score each area relating to patient’s current status. Weights are in parenthesis.
Total weight at bottom.
Page 2 of 2
Unit Standard Fall Prevention Protocol: Use for all Patients at Risk for Falls
• Use appropriate orientation strategies with every interaction for as long as needed.
• Use clear communication.
• Assist patients who have hearing aids and/or glasses, to use them.
• Do comfort rounds every 2–3 hours except at night if the patient is asleep (toileting needs,
hydration, position changes).
• Teach the patient and family about fall risk and prevention strategies. Ask the patient and family
to help prevent falls.
• Make sure the call bell, personal items, and walking aids are in easy reach.
• Find out if the patient is able to use the call bell system.
• Remind patients [who need assistance] to call for help when transferring, getting up, or toileting.
• Help the patient to walk as soon as possible and as often as possible.
• Check assistive devices are used correctly and fixed as needed.
• Use incontinence products that don’t affect the patient’s mobility.
• Have the patient wear non-slip footwear for all transfers and ambulation.
• Check there are no barriers to ambulation or transfers (e.g., clutter in the room and hallway)
• Assign a room, type of bed, bed position, and height that allows safe transfer, ambulation, and
monitoring
• Follow the Least Restraint policy
• Use a bed alarm [when available] to alert staff when patients are trying to get out of bed on
their own
Fall Prevention Initiative, 2009

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