Falls Prevention Screen Date: Time: Initials:

(Acute Hospital)
(Tick as applicable)
Patient Details: Yes No
Is the patient 65 years or older?
If Yes to any of these
Is the patient 50 - 64 years old AND Yes No
please complete the
Had a fall in the past year / admitted with a fall OR Yes No
Multi-factorial Falls
• Help / supervision needed to transfer / walk OR Yes No
Risk Assessment Yes No
• Has a fear of falling OR
below on this Yes No
• A medical condition that, in your judgement, would increase a fall risk; such as stroke, amputee, etc
patient No
Is the patient aged under 50 years AND had a fall in the past year / admitted with a fall? Yes

Mul�-factorial Falls Risk Assessment Interventions Required should be incorporated in the main nursing care plan
Risk Factor Active Problem - High risk medications prescribed during Consider the following: Date & Time
in-patient stay Liaise with the prescriber regarding new
high risk medications prescribed
MEDICATION

Benzodiazepines; No Yes
If Yes , consider Liaise with the pharmacist regarding high
hypnotics/anxiolytics the following risk medications prescribed
Identification of Antipsychotics No Yes
high risk Evidence for prescribing rationale completed:
Antidepressants No Yes (See Psychotropic Prescribing Algorithm)
medications for falls
No Yes

Lying and standing blood No Yes Consult Medical Team

HYPOTENSION
ORTHOSTATIC

pressure reading indicates

Review of antihypertensives
probable orthostatic If Yes , consider and / or diuretics
hypotension the following
Patient reports feeling dizzy / No Yes
Cardio-vascular
lightheaded / fainting episodes
OH

or loss of consciousness within

the last year

Patient’s admission to hospital is No Yes

Refer to Physiotherapy
a result of a fall
Ensure patient’s walking aid is available
Patient had a fall in last 12 months No Yes and accessible
MOBILITY

Patient reports fear of falling No Yes Refer to Occupational Therapy

If Yes , consider
Patient reports or staff note No Yes the following Provide patient with Falls Prevention
unsteady gait - require assistance Leaflet
Mobility /supervision to mobilise
Needs Ensure Call Bell is within easy reach and
Does the patient require No Yes advise patient re use of same
assistance to stand
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 Risk Factor Active Problem Consider the following: Date & Time

Patient/carer report or staff No Yes Care plan reflects needs with supervision/assistance
note known history of Cognitive If Yes , consider with ADLs
Impairment/ Dementia the following

Memory/Mood No Yes Inform Medical Team of Delirium for review

Evidence of Delirium
(e.g. 4 AT score 4 or more)
SAFETY - Personal

Patient report / staff note No Yes Ensure glasses or visual aids are available/reachable
vision impairment at admission If Yes , consider & clean
Visual the following
Impairment

Patient needs assistance No Yes Consider care plan needs for assistance with toileting
mobilising to toilet If Yes , consider
the following Ensure accessible Call Bell is in place
Access to Toilet

Inappropriate Footwear No Yes Request alternative suitable footwear

If Yes , consider
the following Supply alternative safe footwear if available
Footwear

Patient gets up during No Yes Consider night-time toileting needs

SAFETY - Environment

the night If Yes , consider

the following Consider the need for observation/supervision
Ensure accessible Call Bell is in place
Night-time Risk

Inadequate Lighting No Yes Ensure adequate lighting in place

No If Yes , consider
Call Bell not in place Yes the following Ensure environment is clutter free
Trip Hazards No Yes Partner with Older Persons Council for
Environment Walkability Study in your area
Screen

[An alarm device does not replace regular visual checking of the patient who is at risk of falling]

Date: Time: Initials: Refer to local Falls Prevention / Management Policy

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