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,

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.

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