HD Falls ED Audit Forms
Audit Form
ED Screening Audit
ED Intervention Audit
Hospital System
A Demo
A Demo LD
Advocate Health
Advocate Health ED
Appleton Area Health
Aspirus
Astera Health
CentraCare
Craig Hospital
Demo System
Emory
First Health
Grady
Henry Ford
Houston Methodist
KP Mid Atlantic
KP NW
KP SCALHI
KP Seattle Capitol Hill
LCMC
Mary Greeley
Meeker Memorial
Mosaic Life Care
Overlake Medical Center
Parkland
SIH
St Tammany
UAMS
University of Illinois Chicago
UT Southwestern
VCU
White River
Willis Knighton
Hospital Name
Unit Name
Date
ED Screening Audit
Total Screened Correctly
Total Screened Incorrectly
Dizziness/Generalized Weakness
Immobilized/Requires Assist of One Person
Assist Device/Requires Assist of Two People
History of Depression/Anxiety
History of ETOH/Substance Abuse
ED Intervention Audit
Total Criteria Met
Total Criteria Unmet
Fall ID
Fall Sign
Call Light within Reach
Assistive Device/Belonging within Reach
Stretcher Low and Locked
Side Rails Up on Stretcher
Exit Alarm
(If Applicable)
Pt/Family Educated on Fall Risk/Call For Help Prior to Getting Up
Hourly Rounding
Hourly Toileting Opportunities
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