Fall Assessment Tool The Humpty Dumpty Scale Parameter Age Criteria Score Less than 3 years old 3 to less than 7 years old 7 to less than 13 years old 13 years old and above 4 3 2 1 Male Female 2 1 Neurological Diagnosis Alteratons in Oxygenation (Respiratory Diagnosis, Dehydraton, Anemia, Anorexia, Syncope/Dizziness, etc.) Psych/Behavioral Disorders Other Diagnosis 4 3 Not Aware of Limitatons Forget Limitatons Oriented to own Ability 3 2 1 History of Falls or Infant-Toddler Placed in Bed Patent uses assistive devices or Infant Toddler in Crib or Furniture/Lightng (Tripled Room) Patent Placed in Bed Outpatient Area 4 Within 24 hours Within 48 hours More than 48 hours/None 3 2 1 Multple Usage of: Sedatives(excluding ICU patients sedated and paralyzed) Hypnotcs Barbiturates Phenothiazines Antdepressants Laxatves /Diuretics Narcotics 3 One of the Meds listed above Other Medicatons/None 2 1 Gender Diagnosis 2 1 Cognitve Impairments Environmental Factors 3 2 1 Response to Surgery/Sedation/ Anesthesia Medicaton Usage Total Fall Risk Low Humpty Dumpty Score = 7-11 High Risk Humpty Dumpty Score = 12 or above
