This article describes the development of a fall risk assessment tool for hospitalized patients that became the key component in a fall prevention program at one medical center. The characteristics of 102 patients who fell were compared with those of 102 patients matched by age and length of stay who did not fall. The statistically significant differences found between these two groups of patients were used to develop a fall risk assessment tool that was further tested on 334 patients for reliability and validity. This assessment tool was used in conjunction with a standardized nursing care plan, fall risk alert signs and stickers, a written nursing evaluation of all falls, and new safety equipment as part of an integrated fall prevention program. In the 12 months following the institution of the fall prevention program, decreases in monthly falls per patient day have averaged 20% lower than peak levels in 1988, or 41 falls per 10,000 patient days.