humpty dumpty falls scale
DESCRIPTION
(Pediatric)TRANSCRIPT
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Humpty Dumpty Falls Scale
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Humpty Dumpty Falls Scale
Deborah Hill-Rodriguez
Miami Children’s Hospital
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P Falls Assessment Tool
The Humpty Dumpty Scale
Parameter Criteria Score
(circle)
Age
Less than 3 years old 4
3 to less than 7 years old 3 7 to less than 13 years old 2
13 years and above 1
Gender Male 2 Female 1
Diagnosis
Neurological Diagnosis 4 Alterations in Oxygenation
(Respiratory Diagnosis, Dehydration, Anemia,
Anorexia, Syncope/Dizziness, etc).
3
Psych/Behavioral Disorders 2 Other diagnosis 1
Cognitive Impairments
Not Aware of Limitations 3 Forgets Limitations 2
Oriented to own ability 1
Environmental Factors
History of Falls or Infant-Toddler placed in bed 4
Patient uses assistive devices or infant-toddler in crib or
youth bed. 3
Patient placed in bed 2
Outpatient Area 1
Responses to Surgery/Sedation/Anesthesia
Within 24 hours 3 Within 48 hours 2
More than 48 hours/None 1
Medication Usage
Multiple usage of: Sedatives (excluding ICU
patients sedated and paralyzed) Hypnotics
Barbiturates Phenothiazines Antidepressants
Laxatives/Diuretics Narcotic
3
One of the meds listed above 2 Other Medications/None 1
Total
Name: __________________ File No: _____________ Age: _____________ Date: _____________ Ward: _____________ Name & Sig. _________________
Preventing falls, enhancing safety
Minimum Score 7
Maximum Score 23
Risk for Falls IF score is 12 or below
High Risk for Falls IF score is 12 or above
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Patient Information
Name:
File Number:
Age:
Date:
Ward:
Name & Signature:
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Age & Gender
Parameter Criteria Score
AGE < 3 years old 4
3 to < 7 years old 3
7 to < 13 years old 2
> 13 years old 1
GENDER Male 2
Female 1
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Diagnosis
Parameter Criteria Score
DIAGNOSIS Neurological Diagnosis 4
Alteration in Oxygenation 3
Psych/Behavioral Disorders 2
Other Diagnosis 1
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Cognitive Impairments
Parameter Criteria Score
COGNITIVE IMPAIRMENTS
Not aware of limitations 3
Forgets limitations 2
Oriented to own ability 1
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Environmental Factors
Parameter Criteria Score
ENVIRONMENTAL FACTORS
Hx of Falls or infant-Toddler placed on bed
4
Uses assistive device or infant-toddler in crib or
youth bed
3
Patient placed in bed 2
Outpatient Area 1
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Responses to Surgery/Sedation/Anesthesia
Parameter Criteria Score
RESPONSES TO SURGERY/SEDATION/
ANESTHESIA
Within 24 hrs 3
Within 48 hrs 2
> 48 hrs/None 1
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Medication Usage
Parameter Criteria Score
MEDICATION USAGE
Multiple usage of sedative, hypnotics, barbiturates,
phenothiazines, antidepressants,
laxatives/diuretics, narcotics
3
One of the meds listed above 2
Other medications/None 1
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Humpty Dumpty Fall Risk Assessment
Seven (7) Parameters
Minimum score per parameter = 1
Any not applicable parameter = 1
If multiple categories = give the highest
Highest score = 23
Lowest score = 7
Interpretation:
7-11: Low Risk
>12: High Risk
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