NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00303 |
|---|---|
| Label | Risk for adult falls |
| Spanish label | Riesgo de caídas del adulto |
| Domain | 11. Safety / protection |
| Class | 2. Physical injury |
| Type | Risk |
| Status | Current |
What it means
An adult who has not fallen yet, or who has fallen before, has personal or environmental characteristics that make it likely they will end up on the floor unintentionally and get hurt. The diagnosis is meant for acting before the fall, not after.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Hospitalized older adults, especially at night.
- Patients with dizziness or weakness, or who take sedatives, antihypertensives or diuretics.
- After surgery and during the first attempts to walk.
- Confusion, delirium or cognitive impairment.
- Vision problems, inappropriate footwear or wet floors.
- A high-risk score on the scale your facility uses.
What to assess
- Fall risk with a validated scale per your facility's policy, such as the Morse Fall Scale or the Downton index, on admission and whenever the patient's condition changes.
- Falls in the past year: how many, how they happened and whether there was injury.
- Medications that cause drowsiness, dizziness or urinary urgency, and when they are given.
- Lying and standing blood pressure: a systolic drop of 20 mmHg or more indicates orthostatic hypotension.
- Gait, balance and use of assistive devices.
- Mental status: orientation and ability to call for help.
- Vision, hearing and the footwear they use.
- Environment: bed height, side rails, lighting, call light within reach.
Risk factors
What makes the problem more likely, and what nursing can monitor or modify.
- Dizziness or a drop in blood pressure when going from lying to sitting or from sitting to standing.
- Urinary urgency, especially at night, that makes them get up in a hurry.
- Open-toed shoes, backless slippers or walking in socks.
- Muscle weakness or unsteady gait without using the assistive device they need.
- Does not call for help to get up or does not know how to use the call light.
- Not wearing their glasses or hearing aids during the hospital stay.
- Unfamiliar surroundings, poor lighting at night, wet or cluttered floors.
- Fear of falling that makes them stiff and unsteady when walking.
- Dehydration or prolonged fasting.
- Insufficient knowledge of fall prevention by the patient or family.
At-risk populations
- Adults 65 and older.
- People with one or more falls in the past year.
- Patients in the first days of a hospital stay or after a unit transfer.
- Postoperative patients who are starting to walk.
- Older adults who live alone.
- People with cognitive impairment or delirium.
Associated conditions
- Stroke, Parkinson's disease and peripheral neuropathy, such as diabetic neuropathy.
- Dementia and delirium.
- Orthostatic hypotension, arrhythmias and anemia.
- Hip or knee osteoarthritis and recent joint replacement.
- Cataracts, glaucoma or other vision loss.
- Treatment with sedatives, hypnotics, opioids, antihypertensives, diuretics or multiple medications at once.
Risk factors are the ones nursing can change: footwear, the environment, how the patient gets up, what they know. Associated conditions (a stroke, Parkinson's disease, taking diuretics or sedatives) raise the risk but are not corrected with independent nursing interventions. If your program requires it, write them as "in a patient with...".
How to write it (PES)
Risk for adult falls related to dizziness on rising, inappropriate footwear and nighttime urinary urgency, in a 78-year-old patient on diuretics and antihypertensives (associated condition).
As a risk diagnosis, it has no "as evidenced by." If the patient has already fallen, document the event, assess for injuries and revise the care plan.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient remains free of falls during the hospital stay.
- Uses the call light to ask for help before getting up 100% of the time at night.
- Gets up in two steps (sit first, then stand) every time.
- Wears closed-toe, nonskid footwear when walking.
- Patient or family names three measures to prevent falls at home before discharge.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Complete the fall risk scale on admission, after treatment changes and after any fall. | Risk changes with medications and the patient's course. |
| Keep the bed in low position with brakes locked and the call light within reach. | These are the environmental measures with the greatest impact. |
| Identify the patient as a fall risk according to facility protocol. | The whole team knows the patient needs supervision. |
| Schedule toileting, especially if the patient takes diuretics. | Many falls happen when patients get up in a hurry to urinate. |
| Teach the patient to get up in two steps. | It reduces dizziness from orthostatic hypotension. |
| Review medications that increase risk with the provider. | Adjusting doses or timing can lower the risk. |
| Keep a night light on and the floor dry and clear. | It removes tripping and slipping hazards. |
| Ask the family to bring in glasses, hearing aids and closed-toe shoes. | Seeing and hearing well, and stable footing, reduce trips. |
| Stay with the patient for the first walk after surgery or a medication change. | That is when they are most unsteady. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 1909Fall Prevention Behavior
- 0208Mobility
- 1912Falls Occurrence
NIC interventions
- 6490Fall Prevention
- 6486Environmental Management: Safety
- 0221Exercise Therapy: Ambulation
- 6610Risk Identification
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Older adult on a diuretic in the hospital
Patient. Ernesto, 81, is admitted for pneumonia. He has taken a diuretic and an antihypertensive for years. At home he fell once four months ago, getting up at night to go to the bathroom.
Assessment
- Morse score of 65 (high risk).
- BP lying down 134/78 mmHg; standing, 110/68 mmHg at one minute, with dizziness.
- Gets up to urinate 3 times a night.
- Wears backless slippers; left his glasses at home.
- Oriented, but has not used the call light: says he doesn't want to be a bother.
- Walks slowly with a cane.
Nursing diagnosis
Risk for adult falls related to dizziness on rising, nighttime urinary urgency, inappropriate footwear, not wearing his glasses and not calling for help to get up, in an 81-year-old patient with orthostatic hypotension on diuretic and antihypertensive therapy (associated conditions).
Goal
Ernesto remains free of falls during the hospital stay and uses the call light every time he gets up at night.
Interventions
- Low bed with brakes locked, call light and urinal within reach, and a night light.
- Teach him to sit for one minute before standing.
- Ask the family to bring his glasses and closed-toe shoes.
- Hourly rounding at night with an offer to use the bathroom.
- Discuss diuretic timing with the provider to avoid a nighttime dose.
Evaluation
After 4 days he has had no falls, uses the call light at night and gets up in two steps. His Morse score is still high because of his age and gait, so the diagnosis stays active until discharge and the family receives a fall prevention plan for home.
How it differs from similar diagnoses
- Risk for child falls (00306): Risk for child falls: the same idea applied to children, with age-specific factors.
- Impaired physical mobility (00085): Impaired physical mobility describes the limitation in movement; risk for adult falls describes the likelihood of falling.
- Risk for physical injury (00336): Risk for physical injury is broader and includes bumps, burns and other harm. If the specific concern is falling, use 00303.
Common mistakes
- Still using the old risk for falls code: the current classification uses 00303 for adults and 00306 for children.
- Adding "as evidenced by" to a risk diagnosis.
- Assessing risk only on admission and not after treatment changes.
- Writing only "related to advanced age": age cannot be changed; name factors you can act on.
- Relying on side rails alone for a confused patient: they may try to climb over them and fall from a greater height.
Assessment scales
Used in these conditions
Other diagnoses in the Physical injury class
Domain 11, Safety / protection. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for risk for adult falls?
00303, in Domain 11 (Safety/protection), Class 2 (Physical injury). For children, use 00306 (Risk for child falls).
Which fall risk scale should I use?
The one your facility uses. The Morse Fall Scale and the Downton index are two of the most common. On the Downton index, a score of 3 or more indicates high risk.
Can I use it if the patient has already fallen?
Yes. A previous fall is one of the strongest predictors of another. After a fall, assess for injuries and adjust the plan.
Does risk for adult falls have an "as evidenced by" part?
No. It is a risk diagnosis, so it only includes risk factors, plus associated conditions if your program asks for them.
What nursing diagnoses usually go with risk for falls?
Impaired physical mobility (00085), Acute confusion (00128) and Risk for adult pressure injury (00304), depending on the case.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Risk for adult falls (00303) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2. Reviewed November 2, 2026.