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STEADI fall risk assessment form

STEADI fall risk assessment form

Implement the CDC’s STEADI initiative with this fall risk assessment form. It provides a structured approach to identifying and managing fall risks in older adults. Use this form to enhance safety and support healthy aging.

Use this template
or download pdf
STEADI fall risk assessment form

Implement the CDC’s STEADI initiative with this fall risk assessment form. It provides a structured approach to identifying and managing fall risks in older adults. Use this form to enhance safety and support healthy aging.

Use this template
or download pdf

About the STEADI fall risk assessment form

Implementing a STEADI fall risk assessment form template is crucial for healthcare professionals focused on preventing falls. This template provides a structured approach to evaluating risk factors based on evidence-based guidelines from the CDC’s STEADI initiative. 

By using this form, you ensure comprehensive and standardized assessments, which are vital for identifying potential fall risks accurately. The template helps you streamline your workflow by offering clear sections for documenting patient history, medications, and balance assessments. 

This clarity allows you to focus on creating effective intervention plans tailored to each patient’s needs. Additionally, the template facilitates consistent documentation, which is essential for tracking progress and adjusting care plans over time. By adopting a STEADI fall risk assessment form, you not only enhance patient safety but also improve the quality of care provided. 

Key elements of a STEADI fall risk assessment form template

A STEADI fall risk assessment form template is designed to help you systematically evaluate and mitigate fall risks. Here are the essential elements to include:

  • Patient demographics and history: Begin by capturing vital information such as the patient’s age, gender, and medical history. This foundational data helps you tailor the assessment to each individual’s specific needs, ensuring a personalized approach to fall prevention.
  • Medication review: Evaluate the patient’s current medications to identify those that may increase fall risk. This section is crucial for understanding potential side effects and interactions that could impair balance or coordination, allowing you to implement appropriate interventions.
  • Balance and gait assessment: Conduct tests to assess the patient’s balance, gait, and strength. These evaluations help you determine the patient’s mobility level and identify areas that require targeted interventions, such as physical therapy or assistive devices.
  • Environmental and lifestyle factors: Document potential hazards in the patient’s living environment, such as poor lighting or cluttered walkways. Additionally, consider lifestyle factors like physical activity levels. Addressing these elements can significantly reduce fall risks and enhance overall safety.

By incorporating these key elements, you ensure comprehensive and effective fall risk assessments, ultimately improving patient care and safety.

How to use a STEADI fall risk assessment form template

Effectively using a STEADI fall risk assessment form template involves a few straightforward steps to ensure comprehensive evaluations and improved patient safety. Begin by accessing the editable template within the app. 

Customize the fields to suit your specific needs, such as adding patient demographics or specific risk factors relevant to your facility. This customization ensures the template aligns perfectly with your workflow.

During the initial assessment, gather detailed patient information, including medical history and current medications. This information forms the basis for identifying potential fall risks and tailoring interventions. Ensure all team members are trained to gather and input this data accurately.

Next, conduct assessments using the template to perform balance and gait evaluations. Document your findings in the designated sections, noting any areas that require attention. This step is crucial for developing targeted intervention plans to enhance patient mobility and safety.

Based on the assessment results, implement action plans by outlining preventive measures and assigning responsibilities to team members. Utilize the app’s action management feature to track the implementation of these plans, ensuring accountability and timely follow-up.

Finally, review and update the template regularly to reassess risk factors and adapt to changes in patient conditions. Consistent monitoring is key to reducing fall incidents and improving outcomes. By following these steps, you can seamlessly integrate the STEADI fall risk assessment form template into your workflow, enhancing both patient safety and the quality of care provided.

Related categories

  • Risk management and compliance templates
  • Health care templates
  • Risk assessment templates
Preview of the template
Page 1
Patient Information
Patient Name
Address
Age
Fall History
Have you fallen in the past year?
If yes, how many times?
Balance Assessment
Timed Up and Go Test (seconds)
4-Stage Balance Test
Screening Tools
Medication Review
Vision Screening
Hearing Screening
Action Triggers
Timed Up and Go >12 seconds
Unable to hold 4-Stage Balance Test
2 or more falls in past year
Recommendations
Recommendations for Fall Prevention
Signatures
Date
Clinician Signature

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

Fall protection: A guide to staying safe at heightsDynamic risk assessment: Your guide to proactive management (with real world case studies)Effective risk assessment: Key steps and best practicesEnvironmental risk assessment: A step-by-step guide
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Template collections

See comprehensive collections of best practice templates related to this topic.

9 free fall risk assessment form templates 3 free elderly home safety checklists to reduce risksTop 6 free fall protection inspection forms3 free ISO 31000 risk assessment templates
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Use cases

Check out how the Lumiform software can be utilized for related use cases.

Healthcare risk management softwareRisk assessment softwareRisk management software for anticipating and adressing safety risksApply Lumiform's workflow automation platform to all use cases
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Other resources

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5 Types of workplace hazards5 types of incident reportsHow to evaluate compliance measuresDisaster risk management: the philosophy of disaster preparedness

Frequently asked questions

What is the purpose of a STEADI fall risk assessment form?

The purpose of a STEADI fall risk assessment form is to systematically evaluate and mitigate fall risks in patients. It provides a structured approach based on CDC guidelines, helping healthcare professionals identify potential hazards and implement preventive measures to enhance patient safety and care quality.

How can a STEADI fall risk assessment template be integrated into daily practice?

Integrating a STEADI fall risk assessment template into daily practice involves training staff to use the template effectively and customizing it to meet specific patient and facility needs. Regular use ensures consistent evaluations, enabling timely interventions and fostering a safer environment for patients.

Why should healthcare facilities use a STEADI fall risk assessment template?

Healthcare facilities should use a STEADI fall risk assessment template to ensure comprehensive and consistent evaluations of fall risks. This form helps standardize the assessment process, reduce incidents, and maintain compliance with healthcare regulations, ultimately improving patient outcomes and safety.

How does regular use of a STEADI fall risk assessment template benefit patients?

Regular use of a STEADI fall risk assessment template benefits patients by ensuring ongoing monitoring and adaptation of care plans based on changing conditions. This proactive approach helps prevent falls, enhances safety, and supports better health outcomes through tailored interventions.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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