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
Alterations in Oxygenation (Respiratory
Diagnosis, Dehydration, Anemia,
Anorexia, Syncope/Dizziness, etc.)
Psych/Behavioral Disorders
Other Diagnosis

4
3

Not Aware of Limitations

Forget Limitations
Oriented to own Ability

3
2
1

History of Falls or Infant-Toddler Placed

in Bed
Patient uses assistive devices or Infant
Toddler in Crib or Furniture/Lighting
(Tripled Room)
Patient Placed in Bed
Outpatient Area

Within 24 hours
Within 48 hours
More than 48 hours/None

3
2
1

Multiple Usage of:

Sedatives(excluding ICU patients sedated
and paralyzed)
Hypnotics
Barbiturates
Phenothiazines
Antidepressants
Laxatives /Diuretics
Narcotics
One of the Meds listed above
Other Medications/None

Gender

Diagnosis

2
1

Cognitive Impairments

Environmental Factors

2
1

Response to Surgery/Sedation/
Anesthesia

Medication Usage

Total

Fall Risk
Low Humpty Dumpty Score = 7-11
High Risk Humpty Dumpty Score = 12 or above

2
1