Fall Risk Assessment (QMS-F074) FALL RISK ASSESSMENT (QMS-F074) Updates Document Ref: QMS-F074 (Fall Risk Assessment) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Safe (Mitigating Risk) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Fall HistoryHas the service user experienced a fall in the last 12 months?- Select -Yes (1 fall)Yes (2 or more falls)No known fallsUnsure / No history availableDetails of recent fallsSECTION 2 - Health & Medical Risk FactorsIdentify all health factors present that increase fall risk: Polypharmacy (Taking 4 or more prescribed medications) Use of sedatives, anti-depressants, or blood pressure medication Visual impairment (e.g., cataracts, glaucoma, macular degeneration) Cognitive impairment (e.g., Dementia, delirium, confusion) History of strokes or Parkinson's Disease Incontinence or urinary urgency (Rushing to the toilet) Dizziness / Vertigo / Postural hypotension (Blood pressure drops when standing) None of the aboveDoes the service user experience foot problems or wear inappropriate footwear?- Select -Yes (Requires podiatry input or safe slippers/shoes)No (Safe footwear observed)SECTION 3 - Mobility & Behavioural FactorsWalking Aid Usage- Select -Uses aid correctly at all timesFrequently forgets or refuses to use prescribed aidUses furniture to "cruise" around the roomNo walking aid requiredImpulsivity RiskDoes the service user attempt to stand or walk unassisted despite lacking the physical capability to do so safely?Yes (High impulsivity risk)NoSECTION 4 - Risk Control Measures & Sign-offOverall Fall Risk Rating- Select -LOW RISK (Standard care observations)MEDIUM RISK (Implement preventative measures)HIGH RISK (Urgent multidisciplinary intervention required)Preventative Action Plan- Select -Referral to Local Authority Falls Prevention TeamReferral for Physiotherapy / Occupational TherapyGP review of current medications requestedTelecare installation requested (e.g., pendant alarm, fall sensor)Ensure walking aids are within reach before care worker leavesEnsure adequate lighting is left on overnightSpecific Instructions for Care WorkersAssessor NameDate of AssessmentSave Fall Risk Assessment
