Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Fall risk assessment

  • On admission, fall risk assessment done

  • Does the patient risk assessment reveals vulnerable category

  • Oriented patient on fall prevention safety measures in the bedside - Side rails, Using Call bell

  • Upon admission, education given on fall prevention to Patient & Attender and documented

  • Ensure about Environment - Inadequate lighting, Wet Toilet Floor, Uncleared Clutters.

  • Patient participation - Patient with no attendent, Pateint left the bed without asking for help, Unavailability of eye glasses, hearing aids

Accuracy of Checking in :

  • Patient Information - Age more than 60, Language Barrier, Impaired Hearing,

  • Clinical Information - History of Fall, Secondary diagnosis ≥ 2 Medical diagnosis in Chart ((Associated with incontinence, vision problems, Multiple Medicines, Orthostatic hypotension), Intravenous Therapy/ IV Channel

  • Mental Status - Oriented at all times or Comatosed, Confused / Forgets / Over estimates limitations / Agitated,

  • GAIT - Normal/Bed rest/Wheel Chair, Weak, Impaired

  • Ambulatory Aid - Normal/Bed rest/Wheel Chair, Crutches/Cane/Walker, Furniture

  • Defined the RISK - Low risk, Moderate Risk, High Risk.

  • Every shift Fall risk assessment done & Documented

  • Every shift Fall risk Prevention education done & got signed by Attender

  • On Admission Assessment done By S/N

  • Counter signed By I/C

  • Is it Accuracy attained in admission Assessment.

  • Number of staffs involved. & Their Names

  • Findings :

  • Detail of Spot Teaching

  • Name & Sign of Staff who attined Non Compliance

  • Name & Sign of Incharge.

  • NAME & SIGNATURE OF AUDITOR

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