Development and History of the JHFRAT
Recognizing the need for a standardized approach to patient fall prevention, Johns Hopkins Hospital nurses initiated a fall safety project in 2003. This effort, led by clinical nurse specialists and researchers, resulted in the development and piloting of the initial tool. After further testing and feedback from clinical experts, a revised version was introduced in 2007. The rigor of its development helped ensure its high acceptability among clinical staff. Since its implementation, healthcare organizations using the JHFRAT have reported significant reductions in fall rates. The tool is now a licensed product that hospitals can integrate into their electronic health record (EHR) systems.
Components of the JHFRAT
The JHFRAT is divided into two parts: an initial screen and a detailed scoring assessment. The screen first checks for conditions that automatically classify a patient into a high or low-risk category, such as a fall during the current hospitalization or being completely immobilized. If a patient does not meet these criteria, a detailed assessment is performed by evaluating seven key risk factor categories.
- Age: Points are assigned based on the patient's age category (e.g., 60-69 years, 70-79 years, or ≥ 80 years).
- Fall History: Evaluates if the patient has experienced a fall within the past six months.
- Elimination, Bowel, and Urine: Assesses incontinence, urgency, or frequency, which can lead to increased trips to the bathroom.
- Medications: Considers high-risk medications, such as narcotics, sedatives, or diuretics, as well as recent sedated procedures.
- Patient Care Equipment: Accounts for devices that can tether a patient, like IV lines, chest tubes, or catheters.
- Mobility: Includes factors like requiring assistance, having an unsteady gait, or impaired mobility.
- Cognition: Screens for altered awareness, impulsive behavior, or a lack of understanding regarding their condition.
Scoring and Risk Stratification
Each risk factor category in the JHFRAT has a specific point value. A healthcare provider adds up the points based on the patient's condition to calculate a total risk score, which determines their fall risk level.
- Low Fall Risk: A total score of less than 6 points.
- Moderate Fall Risk: A total score of 6 to 13 points.
- High Fall Risk: A total score greater than 13 points.
Once a risk level is assigned, the healthcare team can implement a tailored fall prevention protocol. The JHFRAT is typically performed upon admission and then reassessed regularly, such as every shift or whenever there is a significant change in the patient's condition.
JHFRAT vs. Morse Fall Scale: A Comparison
Both the JHFRAT and the Morse Fall Scale (MFS) are well-known tools for assessing fall risk in acute care settings, but they have distinct differences in their design and predictive focus.
| Feature | Johns Hopkins Fall Risk Assessment Tool (JHFRAT) | Morse Fall Scale (MFS) |
|---|---|---|
| Development | Developed by Johns Hopkins Hospital nurses to address specific inpatient needs. | Developed to identify fall-prone patients in clinical settings. |
| Focus | Provides a comprehensive, multi-factor assessment that can reflect acute changes in a patient's condition. | Emphasizes history of falls and gait, with less weight on factors like medication. |
| Components | Includes age, fall history, elimination issues, medication, equipment, mobility, and cognition. | Focuses on fall history, secondary diagnosis, ambulatory aid, IV/saline lock, gait, and mental status. |
| Scoring | Points are assigned based on age and clinical factors, with a higher score indicating higher risk. | Points are assigned based on six categories, with a higher score indicating higher risk. |
| Predictive Accuracy | Found to be effective in identifying at-risk patients, especially when re-evaluated regularly to track changes. | Well-established and widely used, though studies have shown varied predictive performance compared to JHFRAT in certain settings. |
The Clinical Impact of Using the JHFRAT
The JHFRAT is a critical component of a hospital's broader fall prevention program. Its use helps clinicians quickly and consistently identify high-risk patients and implement targeted interventions. This reduces the incidence of falls and fall-related injuries, which can lead to longer hospital stays and increased costs. By leveraging the tool's structured and evidence-based approach, healthcare teams can standardize their assessment process, improve communication, and ultimately enhance overall patient safety. While validation studies show high sensitivity, some indicate lower specificity, suggesting the need for careful application alongside clinical judgment.
Conclusion
The Johns Hopkins Fall Risk Assessment Tool is a robust, evidence-based instrument for evaluating fall risk in adult inpatients. By assessing a range of factors from age and mobility to medication use and cognition, it helps healthcare providers stratify patients into risk categories and implement targeted preventive measures. The tool's integration into clinical practice supports a standardized, proactive approach to patient safety, contributing to reduced falls and improved patient outcomes in acute care settings. Continued research refines its application, ensuring it remains a valuable part of comprehensive fall prevention protocols.
