| Date/day of the week
Time of day/shift
Place the fall occurred
Activity that led to the fall, e.g., patient transfer, during mealtimes
Witnessed/unwitnessed
Injury:
- None- does not cause any type of physical, emotional or psychological harm and requires no medical or nursing care;
- Level I-requires little or no medical care, e.g., abrasions, cuts, or bruises;
- Level II-requires some medical and/or nursing intervention or observation, e.g., sprains, deep lacerations, splinting;
- Level III- requires medical intervention or consultation, e.g., fracture, change in level of consciousness or functional status. |
History of falls
Multiple unit transfers
Age >70
Neurological/motor dysfunction, e.g., cerebral vascular accident, Parkinson's disease
Impaired vision
Impaired cognition
Syncopy, dizziness, or vertigo
Nocturia
Medications-specifically-psychotropics, sedatives, cardiovascular agents, diuretics
Recent medication change
Recent change in status |
Unit census
Patient/staff ratio
Patient Acuity Index
Staff mix
Unit manager present
New admissions to unit
Emergency occurrence on unit, e.g., patient with cardiac arrested, readmission to acute hospital
Agency/temporary personnel working on unit |