Fall Risk Level Tool

Assigning fall risk categories (high, moderate and low) based on the numerical score of a fall risk assessment alone may not always be clinically useful or appropriate. This tool can be used to assist with placing ‘at-risk’ patients/residents into high, moderate, and low fall risk categories and designing appropriate risk reduction strategies. In addition to assessing above risk factors the nurse should also consider these situational factors: New admission, floor-to-floor transfer, post fall, and change of condition and/or starting fall risk medication.

Based on your fall risk assessment results (identified risk factors), place patient/resident into either the high, moderate or low risk category.
Risk Level Criteria
High Risk One or more risk factors present

Impaired mobility

Impaired gait/balance

Impaired mental status
Moderate Risk One or more risk factors present

Absence of mobility and gait/balance impairment
Low Risk Absence of mobility impairment and gait/balance impairment

Absence of risk factors

Tideiksaar, R. Falls in Older People: Prevention and Management. 4th Edition.
Health Professions Press, Baltimore, MD 2010

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