ALL RISK STATUS RISK FACTOR LEVEL RISK SCORE RECENT FALLS
tool – Compatibility Mode Search Gya out References Mailings Review View Help Table Design Layout PART 1: FALL RISK STATUS RISK FACTOR LEVEL RISK SCORE RECENT FALLS none in last 12 months. (To score this, complete history of one or more between 3 and 12 months ago. falls, overleaf] one or more in last 3 months one or more in last 3 months whilst inpatient / resident.. MEDICATIONS not taking any of these. (Sedatives, Anti-Depressants taking one Anti-Parkinson’s, Diuretics taking two… Anti-hypertensives, hypnotics) taking more than two. A WIN – A WIN- A WIN – CO 2 N PSYCHOLOGICAL does not appear to have any of these. (Anxiety, Depression appears mildly affected by one or more. Cooperation, Insight or appears moderately affected by one or more "Judgement esp. re mobility ) appears severely affected by one or more. COGNITIVE STATUS AMTS 9 or 10 / 10 OR intact…. AMTS 7-8 mildly impaired. (AMTS. Hodkinson Abbreviated AMTS 5-6 mod impaired. Mental Test Score AMTS 4 or less severely impaired (Low Risk: 5-11 Medium: Risk: 12-15 High Risk: 16-20) RISK SCORE 20 Automatic High Risk Status: (if ticked then circle HIGH risk below) O Recent change in functional status and / or medications affecting safe mobility (or anticipated) O Dizziness / postural hypotension List Fall Status on Care FALL RISK STATUS: (Circle ): LOW / MEDIUM / HIGH Plan/ Flow Chart IMPORTANT: IF HIGH, COMMENCE FALL ALERT PART 2: RISK FACTOR CHECKLIST YA Vision Reports / observed difficulty seeing – objects / signs / finding way around Y Mobility Mobility status unknown or appears unsafe / impulsive / forgets gait aid Transfers Transfer status unknown or appears unsafe ie over-reaches, impulsive Behaviours Observed or reported agitation, confusion, disorientation jstralia) ? Accessibility: Unavailable Focus 12
ment tool – Compatibility Mode v Search Layout References Mailings Review View Help Table Design Layout Part 2 Continued HISTORY OF FALLS Note: For an accurate history, consult patient/resident / family / medical records. Falls prior to this admission (home or referring facility) and/or during current stay If ticked, detail most recent below) CIRCUMSTANCES OF RECENT FALLS:_Information obtained from (Circle below) ( Where? / Comments) Last fall: Time ago Trip Slip Lost balance Collapse Leg/s gave way Dizziness Previous: Time ago Trip Slip Lost balance Collapse Leg/s gave way Dizziness Previous: Time ago Trip Slip Lost balance Collapse Leg/s gave way Dizziness List History of Falls on Alert Sheet in Patient/Resident Record PART 3: ACTION PLAN (for Risk factors identified in Part 1 & 2, list strategies below to manage falls risk. See tips in FRAT PACK) PROBLEM LIST INTERVENTION STRATEGIES / REFERRALS (Australia) ?Accessibility: Unavailable W
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