Humpty Dumpty

Falls Scale

Humpty Dumpty Falls Scale

Deborah Hill-Rodriguez
Miami Childrens Hospital

Patient Information

Name:
File Number:
Age:
Date:
Ward:
Name & Signature:

Age & Gender

Parameter

Criteria

Score

AGE

< 3 years old

3 to < 7 years old

7 to < 13 years old

> 13 years old

Male

Female

GENDER

Diagnosis
Parameter

Criteria

Score

DIAGNOSIS

Neurological Diagnosis

Alteration in Oxygenation

Psych/Behavioral Disorders

Other Diagnosis

Cognitive Impairments
Parameter

Criteria

Score

COGNITIVE
IMPAIRMENTS

Not aware of limitations

Forgets limitations

Oriented to own ability

Environmental Factors
Parameter

Criteria

Score

ENVIRONMENTAL
FACTORS

Hx of Falls or infant-Toddler
placed on bed

Uses assistive device or

infant-toddler in crib or
youth bed

Patient placed in bed

Outpatient Area

Responses to
Surgery/Sedation/Anesthesia
Parameter

Criteria

Score

RESPONSES TO
SURGERY/
SEDATION/
ANESTHESIA

Within 24 hrs

Within 48 hrs

> 48 hrs/None

Medication Usage
Parameter

Criteria

Score

MEDICATION
USAGE

Multiple usage of sedative,

hypnotics, barbiturates,
phenothiazines,
antidepressants,
laxatives/diuretics, narcotics

One of the meds listed above

Other medications/None

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