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
0
