Fall Risk Audit Form Observation # Observation # Room Room Reviewer: __________________ Date: ___________ Date: __________ Time: ___________ Time: __________ Fall Risk Score = _________ Fall Risk Score = ________ Yes No N/A Yes No N/A Falls History Assessment done on Admission profile. At risk for falls documented in chart. Falls Prevention Education given to patient and/or family. FALL RISK REDUCTION ACTIONS Yes No N/A Yes No N/A (Tailor to Hospital Policies) Falls Risk sign posted near door. Yellow armband in place. Is patient aware of own fall risk? Is sitter or family companion aware of fall risk? patient’s Is call light within reach? Does bed alarm work? Is a bed alarm in use? Is a chair alarm in use? Is the environment free of clutter? Is in patient chart? RN documenting “Falls Precautions” Is RN documenting Bed and/or Chair alarm use in patient chart?
Fall Risk Audit Form Observation # Room Observation # Room Reviewer: __________________ Date: ___________ Time: ___________ Fall Risk Score = _________ Date: __________ Time: __________ Fall Risk Score = ________ Yes No N/A Yes No N/A Falls History Assessment done on Admission profile. At risk for falls documented in chart. Falls Prevention Education given to patient and/or family. FALL RISK REDUCTION ACTIONS (Tailor to Hospital Policies) Yes No N/A Yes No N/A Falls Risk sign posted near door. Yellow armband in place. Is patient aware of own fall risk? Is sitter or family companion aware of patient’s fall risk? Is call light within reach? Does bed alarm work? Is a bed alarm in use? Is a chair alarm in use? Is the environment free of clutter? Is RN documenting “Falls Precautions” in patient chart? Is RN documenting Bed and/or Chair alarm use in patient chart?