Background: Understanding patients' cognitive functional status is critical to prevent adverse outcomes, such as falls and injuries. However, there is variation in nurses' proficiency in assessing patients' cognitive status, and cognitive screening tools often do not provide guidance on safety interventions to keep patients safe. Problem: Lack of appropriate cognitive screening and interventions may have contributed to increased fall rates on an acute care trauma unit. Approach: A comprehensive 6-level Cognitive Pyramid, including guidance on safety interventions for each level, was developed and used during interprofessional Rapid Safety Rounds to assess patients' cognitive status. Outcomes: The Cognitive Pyramid demonstrated appropriate face validity from 12 subject matter experts. After implementing the Cognitive Pyramid during interdisciplinary rounds, the fall rate decreased to 0 per 1000 admissions. Conclusions: Assessment of patients' cognition using the Cognitive Pyramid, and implementing appropriate interventions, may help improve patient safety.