Nursing Skills | Fall Risk Assessment

Fall risk assessment helps nurses identify patients at risk for injury and implement preventive measures. Tools such as the Morse Fall Scale or Hendrich II Fall Risk Model provide structured evaluation of factors including history of falls, mobility limitations, mental status, medications, and gait. Nurses observe for unsteady ambulation, dizziness, or weakness. Environmental hazards such as clutter, poor lighting, or improper footwear increase risk. Interventions include bed alarms, non-slip socks, assistive devices, and frequent rounding. High-risk patients may require closer supervision or room placement near the nursing station. Documentation includes risk score, interventions implemented, and patient response. Effective fall prevention reduces injuries, hospital stays, and healthcare costs.

Hints About Risk Factor Identification

Recognizing intrinsic and extrinsic risks.

Tips About Preventive Interventions

Using alarms, assistive devices, and rounding.

Facts About Environmental Safety

Removing hazards reduces falls.