Using the Johns Hopkins Fall Risk Assessment Tool: Overview and FAQ

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Written by Katherine Zheng, PhD, BSN Content Writer, IntelyCare
A medical professional helps one of his patients walk during a physical therapy session.

Falls are a common cause of injury among older adults. According to the CDC, in one year alone, fall-related injuries contributed to over $50 billion in medical costs. In hospital settings, older adults are at particularly high risk of falls because their reduced mobility from being confined to a room or bed. To combat this preventable issue, the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was created to help providers assess the risk of falls in older patients.

To help your facility incorporate this assessment into your fall prevention protocol, we’ve provided an overview on what this tool is, answering the most frequently asked questions about its use.

What Is the Johns Hopkins Fall Risk Assessment Tool?

JHFRAT is an assessment tool that helps medical staff determine whether an older patient admitted into the hospital is at high or low risk of falls. Similar to other evidence-based falls tools such as the morse fall risk assessment, JHFRAT helps inform appropriate safety interventions (e.g., lower bed positioning or hourly checks) that may be necessary during a patient’s stay.

To pilot the initial use of this falls risk assessment tool, Johns Hopkins medical personnel tested the assessment as part of their evidence-based fall safety initiative in 2005. After observing a noticeable reduction in falls across their own units, Johns Hopkins Hospital launched the tool publicly so that other hospital systems could also incorporate the assessment into their fall prevention strategy.

What’s on the Assessment Tool?

The assessment begins with an initial screener that assesses whether a patient’s fall risk can be determined from their medical history or prior hospital stay. If the screener deems the patient as high or low risk, the rest of the assessment doesn’t have to be conducted. If their risk is still unknown, healthcare providers use the remainder of the tool to assess the following areas:

  • Age category
  • Fall history
  • Elimination, bowel, and urine
  • Medications (specific high-risk medications listed in tool)
  • Patient care equipment (any equipment tethering a patient)
  • Mobility
  • Cognition

The full assessment tool displays all of the specific factors that are listed under each of these seven areas.

How Is the Johns Hopkins Fall Risk Assessment Tool Scored?

As shown in the full assessment tool, each factor listed under the seven assessment areas is assigned a specific point value. If a factor is checked off by a healthcare provider, the allotted point value is added to the patient’s total risk score. Based on a patient’s total score at the end of the assessment, the following fall risk assessment scale is applied:

  • Less than 6 total points = Low fall risk
  • Between 6-13 total points = Moderate fall risk
  • Greater than 13 total points = High fall risk

Who Is This Tool Used For?

This tool was designed to facilitate fall risk assessments in patients older than 60 years of age. As with any fall risk scale, nursing professionals are typically the ones conducting and documenting JHFRAT assessments to inform their plan of care for each patient. This includes registered nurses, licensed vocational nurses, nursing aides, and patient care technicians.

When Should This Tool Be Used?

The time and frequency for using this tool will depend on your facility’s specific protocols for fall prevention. However, the JHFRAT tool is usually incorporated into routine head-to-toe assessments or used during the following events:

  • On admission (usually within 24 hours)
  • Every shift change
  • Upon any change in patient status

How Is JHFRAT Used in Practice?

To get a better idea of how nurses might use this tool in practice, we can take a look at a simplified example below.

Scenario

A 60-year-old female is admitted for a stomach bleed. She has a medical history of seizure disorder and hypertension. She is receiving an IV infusion and taking Gabapentin and Lasix. She has no history of falls, her gait is steady, and she voids with no issues. The previous nurse states that she calls for assistance to the bathroom when she needs to go.

Scoring

From reviewing each factor under the assessment categories in the JHFRAT tool, the patient would receive:

  • 1 point for being between 60-69 years of age
  • 5 points for being on two or more high risk medications (a diuretic and anticonvulsant)
  • 1 point for using a piece of tethered equipment (IV infusion)

The patient’s total score is a 7, which puts her at a moderate risk of falls.

Interventions

The nurse would implement interventions that follow her respective facility’s protocol for moderate-risk patients. Examples of common fall interventions/measures include:

  • Ensuring a patient’s essential items are within reach
  • Putting the patient’s bed rails up with the alarm on
  • Assisting a patient while they’re getting up from bed

Additional JHFRAT Implementation Tips

Beyond understanding how to use the Johns Hopkins Fall Risk Assessment Tool, it’s important that facilities incorporate its use into a more comprehensive fall prevention plan. Follow these tips to maximize the benefits of this tool:

  • Provide staff education. Educate and train the staff who will be responsible for using and documenting scores from this tool at your facility. Staff should understand how and when to use it, where to document scores, and how scores should inform interventions.
  • Create an accessible guide for fall interventions. Create a guide to ensure that staff understand how each risk category should inform a patient’s plan of care. This guide should clearly outline the specific interventions and measures that must be put in place for patients under each category.
  • Outline clear documentation guidelines. Assessing fall risk helps the entire healthcare team develop a safer environment for each patient. Ensure that there is a designated area in your medical charting system where staff can document/reference scores and record relevant notes related to fall prevention.

Discover More Ways to Prevent Injuries and Enhance Patient Safety

The Johns Hopkins Fall Risk Assessment Tool is one of many tools that your facility can adopt to help prevent adverse medical events among your patients. Don’t miss out on IntelyCare’s other free guides designed to help you build a culture of safety at your facility.