peds falls

Have one somewhere, but have to find it. When I find it I will post for you.

Haven't been able to locate the one for peds yet but did find one for adult. Maybe you could modify this. It has a lot on it about ambulating, so that wouldn't be appropriate for anyone who doesn't walk yet. Will continue looking for the peds one for you. This is typed out in a straight format. On the form there are nice boxes for everything.

Adult Fall Risk Assessment Tool

Instructions: Check applicable items and add total score

Category:

I. Age

80 or more years old 3

70-79 years old 1

II. Mental Status

Oriented at all times 0

Confused at all times 3

Intermittent confusion 2

III. Recent Hospitalization

Within last month 2

IV. Elimination

100% dependent 0

Catheter and/or ostomy 1

Elim. with assistance 3

Independent & continent 5

V. Falling within past 6 mos

No hx of falling 0

Has fallen 1or2times before 2

Hx of mult falls/fractures 5

VI. Visual impairment

Visually impaired 1

Wears glasses 1

Assess the pt's gait by having him/her: 1)Stand in 1 spot with both feet on ground

for 30 sec without holding onto something; 2)walk straight forward; 3)walk through

doorway; 4)walk making a turn

VII. Gait and Balance

Wide base support 1

Loss of balance while

standing 1

Balance probs when walking 1

Decrease of muscular

coordination 1

Lurching,swayingorslapping

gait 1

When walking thru a door-

way holds on or changes

gait pattern 1

Jerking or instability when

making turns 1

Use of furniture when trans-

ferring or walking 1

VIII. Meds

ETOH Anesthetic Antihistamines Antihypertensives

Cathartics Diuretics Hypoglycemic Narcotics

Sed/hypnotics Anticonvulsants Psychotropics Benzodiazepines Other

IX. How many meds from the above groups is pt taking?

No meds 0

One med 1

Two or more meds 2

With a change of med and/or dosage in the past 5 days, add one point to the med

score.

Drop in systolic bp of 20 mg Hg or more between lying and standing 2

X. Impairments

Limited ROM/muscle strength 0

None 1

Arm(s) 1

Leg(s) 2

Environment clear 0

cluttered 1

A score of 10 or above indicates a risk of falling. Reassessment to be completed at

least annually or more often as risk indicates.

(HTH)

Still looking for the peds version. Got boxes of junk to go though. When I find it, will be sure to provide the info. As a matter of fact, I may have had two versions of a peds fall risk assessment. Just have to find them.