langcare-fall-risk

name	langcare-fall-risk
description	Assesses fall risk using the Morse Fall Scale and medication-related fall risk factors from FHIR data. Identifies high-risk medications, environmental factors, and mobility impairments. Use when asked to assess fall risk, Morse fall scale, fall prevention, fall risk medications, or patient safety assessment for falls.

Fall Risk Assessment

When to Use This Skill

Use when a clinician needs to evaluate fall risk for hospitalized or ambulatory patients using validated scoring tools and medication review.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (age -- risk increases >65)
2. Use fhir_search to pull Condition resources: fall history, gait/mobility disorders, cognitive impairment, orthostatic hypotension, visual impairment, neuropathy
3. Use fhir_search to pull active MedicationRequest resources; flag fall-risk medications (see references/morse-fall-scale.md): benzodiazepines, opioids, antihypertensives, antipsychotics, antidepressants, sedative-hypnotics, anticonvulsants, anticholinergics
4. Use fhir_search to pull Observation resources: recent vital signs (orthostatic BP), mobility assessments, cognitive screening scores
5. Apply Morse Fall Scale scoring from available data
6. Present risk stratification with specific medication and non-pharmacologic intervention recommendations

FHIR Resources

• Patient -- Age
• Condition -- Fall history, gait disorders, cognitive impairment, visual impairment, neuropathy
• MedicationRequest -- Fall-risk medications
• Observation -- Orthostatic vitals, mobility assessments, cognitive scores, visual acuity

FHIR Query Examples

Pull Fall-Related Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&clinical-status=active")

Pull Active Medications

fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")

Clinical Guidelines

• CDC STEADI (Stopping Elderly Accidents, Deaths & Injuries) Initiative
• Morse Fall Scale for hospitalized patients
• AGS/BGS Clinical Practice Guideline for Fall Prevention (2010, updated)
• NICE CG161 Falls in Older People

Interpretation Guide

• Morse Fall Scale: 0-24 low risk (standard precautions), 25-50 moderate risk (implement fall prevention protocol), >50 high risk (high-risk interventions)
• Count fall-risk medications: >=4 fall-risk medications is an independent risk factor
• Orthostatic hypotension: SBP drop >=20 mmHg or DBP drop >=10 mmHg on standing; correlate with symptoms
• For each high-risk medication, recommend: taper if possible, reduce dose, schedule review, or provide specific rationale for continuing

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges