Johns Hopkins Fall Risk Assessment Tool (JHFRAT): The Seven Categories and How Scoring Differs From Morse

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is the second most common nurse-administered fall-risk screen in U.S. hospitals after the Morse Fall Scale, and it is built differently: instead of picking one severity level per item, JHFRAT works as a checklist of specific risk factors within seven categories, and every risk factor a nurse checks off adds its own points to the total. This page covers the seven categories, the total-score risk tiers, how the tool differs structurally from the Morse Fall Scale, and what the published evidence says about its predictive accuracy. For the program layer around this tool — choosing between JHFRAT and the Morse Fall Scale, building intervention bundles by risk tier, and running a post-fall huddle — see CASRAI’s fall prevention program design guide, which this page complements.

What JHFRAT is, and who built it

JHFRAT was developed at Johns Hopkins Hospital and validated in a study led by Stephanie S. Poe and colleagues, published in the Journal of Nursing Care Quality in 2018 (cited well over 100 times in subsequent fall-risk literature) to “facilitate early detection of risk for anticipated physiologic falls in adult inpatients.” It is distributed today as a licensed package through the Institute for Johns Hopkins Nursing rather than as a free-standing public PDF: an organization licenses the JHFRAT tool (available in English and Portuguese for acute care, plus a separate home-care version), the companion Johns Hopkins Fall Prevention Guidelines by Risk Category, a JHFRAT audit tool, and access to an online instructional course, for a published fee of $1,850 for initial enrollment and $500 per year for renewal (per license, per Johns Hopkins Nursing’s own enrollment page). That licensing model is worth knowing before assuming a hospital can simply adopt JHFRAT the way it might post a public copy of the Morse Fall Scale.

The seven categories, and why it’s a checklist, not a single weighted item

JHFRAT scores a patient across seven categories: age, fall history in the six months before admission, elimination (bowel and bladder pattern), medications (specifically sedatives and antihypertensive drugs classed as high fall-risk), patient care equipment that tethers or restricts mobility (IV lines, catheters, and similar), mobility problems, and cognitive dysfunction. The total score runs from 0 to 35 points.

The structural difference from the Morse Fall Scale is the checklist format. On the Morse Fall Scale, each of the six items is a single selection from a fixed list of mutually exclusive severity levels — you pick one gait description, one ambulatory-aid description, and that item contributes one point value. JHFRAT’s categories instead function as short checklists of specific, independently applicable risk factors: within a category like elimination or medications, a nurse marks each individual condition that is actually present for that patient (yes, this specific risk factor applies), and more than one factor within the same category can be present and contribute at once. That is a real design difference, not just cosmetic — it lets JHFRAT capture that a patient has, say, both an active IV line and impaired mobility, rather than forcing a single score per broad category the way a one-selection-per-item scale does.

CASRAI does not have a verified, primary-source breakdown of the exact point value assigned to every individual checklist item inside each category — that level of detail lives inside the licensed JHFRAT PDF and accompanying Fall Prevention Guidelines, not in any source publicly available to check. Treat the seven-category structure and the 0-35 total range above as the verified facts, and the per-item point table as something to confirm against your organization’s actual licensed copy of the tool, not this page, before using it in a policy or a chart audit.

Interpreting the total score

The published risk tiers, confirmed via a 2024 predictive-validity study in PMC that used JHFRAT as its reference instrument, are:

• Low risk (below 6 points): standard, universal fall precautions.
• Moderate risk (6–13 points): the Johns Hopkins Fall Prevention Guidelines’ moderate-risk interventions — commonly cited examples include keeping essential items within reach, bed rails up with the bed alarm engaged, and assistance during transfers.
• High risk (above 13 points): the Guidelines’ high-risk intervention set, escalated from the moderate tier.

As with the Morse Fall Scale’s commonly-cited 45-point cutoff, treat these bands as the standard published interpretation, not a guarantee that your institution has adopted them verbatim — confirm the exact cutoffs and the specific interventions mapped to each tier in your own organization’s policy, since the JHFRAT license package includes a Fall Prevention Guidelines document meant to be adapted at the facility level, not applied as one universal script.

What the predictive-validity evidence actually shows

A 2024 study (Hong et al., published via PMC, PMC11011889) evaluated JHFRAT’s predictive validity in a stroke-rehabilitation cohort of 175 patients. Using a JHFRAT score of 11 as the empirically optimal cutoff for that specific population, the tool showed an AUC of 0.67 (95% CI 0.49–0.67), 67% sensitivity, and 68% specificity for predicting falls. In the subgroup of patients with low handgrip strength (n=135), predictive performance improved to an AUC of 0.74, 75% sensitivity, and 72% specificity at an optimal cutoff of 12. Two things are worth taking from that: first, JHFRAT’s discriminative accuracy in this study population sits in the “acceptable but not strong” range (an AUC around 0.7 is a common rough threshold cited in the fall-risk literature for a screen worth using but not relying on alone); second, the optimal cutoff the study found (11) is close to, but not identical to, JHFRAT’s own published moderate/high boundary of 13 — a reminder that even the tool’s own developers and subsequent validation studies treat local recalibration as expected practice, not a sign the tool is broken.

JHFRAT vs. the Morse Fall Scale

Both tools sort patients into low/moderate/high fall-risk tiers from a short bedside assessment, and both are widely used — JHFRAT is particularly common in Magnet-recognized hospitals. The practical differences a patient-safety or nursing-quality team should weigh:

• Format: Morse uses one mutually-exclusive selection per item across six items (0–125 total); JHFRAT uses a checklist of independently-applicable risk factors across seven categories (0–35 total). JHFRAT can register multiple concurrent risk factors within one category; Morse cannot.
• Category coverage: JHFRAT explicitly scores medications and tethering patient-care equipment as their own categories; Morse does not score either directly (the Agency for Healthcare Research and Quality recommends pairing the Morse Fall Scale with a separate medication-related fall-risk review for exactly this reason).
• Distribution model: the Morse Fall Scale’s original description is freely available in the published literature; JHFRAT is distributed as a licensed package (tool, guidelines, audit instrument, and training course) through the Institute for Johns Hopkins Nursing.
• Evidence base: both have been validated in multiple settings, but neither is categorically more accurate across every care setting — predictive performance for both varies by population, which is why a team choosing between them should look at validation evidence for their own patient mix rather than a tool’s general reputation. See CASRAI’s Morse Fall Scale guide for the full item-by-item breakdown of that tool, and the fall prevention program design guide for how to build risk-tiered interventions and a post-fall huddle process around whichever screen you use.

Documentation that holds up to a survey or a claim

The same documentation discipline that applies to any fall-risk screen applies to JHFRAT: a surveyor or, after an injurious fall, a plaintiff’s attorney will look for evidence that the score actually drove the intervention, not just that a number was recorded. A chart audit should confirm three things: the assessment was completed on the schedule your policy requires (commonly at admission, then each shift, and after any fall or significant status change), the risk tier the score produced maps to the interventions your organization’s Fall Prevention Guidelines specify for that tier, and a re-assessment happened after each trigger event rather than a stale score carrying over across shifts. CASRAI’s guide to AHRQ Patient Safety Indicators covers how fall-related harm rolls up into the PSI-90 composite that hospitals are measured and paid against.

Frequently asked questions

What is the Johns Hopkins Fall Risk Assessment Tool?

JHFRAT is a nurse-administered fall-risk screening instrument developed at Johns Hopkins Hospital. It scores a patient across seven categories — age, fall history, elimination, medications, patient care equipment, mobility, and cognition — as a checklist of applicable risk factors, producing a total score from 0 to 35 that sorts the patient into a low, moderate, or high fall-risk tier.

How is JHFRAT scored?

Within each of the seven categories, a nurse checks off whichever specific risk factors are actually present for the patient; each checked factor contributes points, and the category totals sum into a single score from 0 to 35. A score below 6 is low risk, 6–13 is moderate risk, and above 13 is high risk, per the standard published interpretation.

What is the difference between JHFRAT and the Morse Fall Scale?

The Morse Fall Scale asks a nurse to pick one severity level per item across six items (0–125 total). JHFRAT instead checks off which specific risk factors apply within seven categories, so more than one factor in a category can contribute at once (0–35 total). JHFRAT also scores medications and mobility-restricting equipment as their own categories, which Morse does not score directly.

Is there a free PDF of JHFRAT available?

Johns Hopkins distributes JHFRAT as a licensed package through the Institute for Johns Hopkins Nursing (published pricing: $1,850 initial enrollment, $500 annual renewal, per license) rather than as a freely downloadable public document. The license includes the tool itself, the companion Fall Prevention Guidelines by Risk Category, an audit tool, and staff training access.

How accurate is JHFRAT at predicting falls?

A 2024 predictive-validity study in a stroke-rehabilitation cohort found an AUC of 0.67 (67% sensitivity, 68% specificity) using JHFRAT’s score, improving to an AUC of 0.74 in a subgroup with low handgrip strength. That places JHFRAT’s discriminative accuracy in an acceptable-but-not-strong range in that study population — consistent with the broader fall-risk literature’s finding that no single bedside screen, JHFRAT or Morse, is a highly precise standalone predictor.

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