Falls are a significant safety concern in healthcare settings, particularly for older adults and patients with impaired mobility or cognition. Identifying which patients are most at risk is the first critical step in preventing falls and related injuries. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is an internationally recognized, evidence-based instrument created by Johns Hopkins nurses for this specific purpose. It provides a standardized method for clinicians, especially nursing staff, to evaluate and stratify adult inpatients based on their potential for falling.
The Components of the JHFRAT
The JHFRAT is comprehensive, evaluating a patient's risk across seven distinct categories. Points are assigned for each risk factor, and the cumulative score determines the overall risk level. By examining multiple facets of a patient's health and circumstances, the tool offers a more complete picture of their risk profile than scales that focus on only one or two factors.
- Age: Older adults are inherently at a higher risk of falling. The JHFRAT assigns points based on specific age brackets.
- Fall History: A recent fall is one of the strongest predictors of future falls. The tool considers any fall within the six months prior to admission.
- Elimination (Bowel and Urine): Factors like urinary urgency, incontinence, or a need for frequent trips to the bathroom can increase fall risk, especially at night.
- Medications: Certain medications, such as sedatives, diuretics, and anticonvulsants, can cause side effects like dizziness, confusion, or weakness, thereby increasing fall risk.
- Patient Care Equipment: Equipment that tethers a patient, such as IV lines, catheters, or telemetry monitoring, can present a tripping hazard and limit mobility.
- Mobility: The tool assesses the patient's walking ability, including unsteady gait, reliance on assistive devices, or impaired mobility. Unsteadiness or impairment scores higher than simple assistance.
- Cognition: Altered mental status, impulsive behavior, or a lack of understanding regarding one's limitations can significantly raise the likelihood of a fall.
Scoring and Risk Stratification
Once a healthcare provider has assessed the patient and assigned points for each category, the total score is calculated. This score is then used to classify the patient into one of three risk levels, which directly inform the type of fall prevention interventions needed.
- Low Fall Risk (Score: Less than 6): Patients in this category receive standard preventative care, which includes orienting them to their surroundings, ensuring call bells are within reach, and encouraging the use of handrails.
- Moderate Fall Risk (Score: 6–13): These patients require more focused interventions. This can include frequent rounding by staff, ensuring the bed is in a low position, and placing fall risk signage on the patient's door.
- High Fall Risk (Score: Greater than 13): This category requires the most aggressive fall prevention strategies. In addition to the interventions for moderate-risk patients, this might include one-on-one observation, bed alarms, and involving physical or occupational therapy.
JHFRAT vs. Other Common Fall Risk Scales
The JHFRAT is not the only fall risk assessment tool available. Hospitals and healthcare systems may use different scales depending on their patient population and specific needs. Here is a comparison of the JHFRAT with two other widely used scales: the Morse Fall Scale (MFS) and the Hendrich II Fall Risk Model.
| Feature | Johns Hopkins Fall Risk Assessment Tool (JHFRAT) | Morse Fall Scale (MFS) | Hendrich II Fall Risk Model |
|---|---|---|---|
| Target Population | Primarily hospitalized adult inpatients, especially those over 60. | All hospitalized adult inpatients. | Hospitalized adult inpatients. |
| Number of Risk Factors | 7 (age, fall history, elimination, meds, equipment, mobility, cognition). | 6 (fall history, secondary diagnosis, ambulatory aid, IV, gait, mental status). | 8 (confusion/disorientation, depression, dizziness, gender, seizures, medications, get up and go test, nocturia). |
| Scoring Range | 0 to 35. | 0 to 125. | Variable; a score of 5 or more indicates a risk. |
| Risk Levels | Low (< 6), Moderate (6–13), High (> 13). | Low (0–24), Moderate (25–45), High (> 45). | Risk (> 4). |
| Focus | Multi-factorial, integrating medical and environmental factors. | Focuses heavily on fall history and physical status. | Incorporates medications and a simple mobility test. |
| Key Strength | Comprehensive assessment of both patient and environmental risks. | Quick and easy to use for routine assessments. | Includes specific medication and mental status indicators. |
Implementing the JHFRAT and Ensuring Prevention
Implementing the JHFRAT is only the first part of a robust fall prevention program. After the assessment, staff must apply a tailored set of interventions based on the identified risk level.
This process includes several key steps:
- Regular reassessment: A patient's condition can change, so reassessments should occur on admission, at every shift change, and following any change in the patient's status.
- Clear communication: All healthcare staff involved in a patient's care must be aware of their fall risk status and the specific interventions in place.
- Staff education: Regular training ensures that all staff understand how to use the JHFRAT correctly and implement the corresponding prevention protocols.
- Environmental modifications: This can involve keeping the patient's environment free of clutter, ensuring adequate lighting, and using non-slip floor mats.
- Patient and family education: Informing patients and their families about fall risks and precautions is a crucial part of prevention.
Conclusion
The Johns Hopkins Fall Risk Assessment Tool is a vital component of any hospital's patient safety strategy. By systematically evaluating a patient's fall risk across multiple dimensions, the JHFRAT enables healthcare providers to move beyond generic precautions and implement specific, evidence-based interventions tailored to each patient's needs. This proactive approach not only helps reduce the incidence of falls and fall-related injuries but also enhances the overall quality of care and patient safety within the hospital environment. Its validated and reliable framework, combined with a comprehensive fall prevention protocol, makes it a powerful tool in safeguarding the well-being of adult inpatients.
For more information on fall prevention strategies for older adults, visit the CDC's STEADI initiative at https://www.cdc.gov/steadi/index.html.
