How to Use the Morse Fall Scale: Overview and FAQ
Inpatient falls are a significant concern for hospitals and post-acute care facilities. They can lead to increased length of stay, injuries, and death. Healthcare facilities have a duty to provide safe environments for patients, which includes taking measures to minimize the risk of falls.
Healthcare facilities often have fall prevention programs and protocols in place, such as risk assessments, staff training, and environmental modifications. One of the most common fall risk assessment tools is the Morse Fall Scale. In this article, we discuss ways to implement a fall risk tool at your facility using Morse as an example.
What Are the Implications of Inpatient Falls?
The World Health Organization (WHO) defines a fall as “an event that results in a person coming to rest inadvertently on the ground, floor, or other lower level.” A fall can cause serious injury for patients already experiencing other health complications. Below are a few startling statistics concerning inpatient falls:
- Nearly 1 million patients fall in hospitals annually.
- Almost 37% of all falls result in injury.
- Falls result in 250,000 injuries and 11,000 deaths in hospitals annually.
Falls are the most reported type of adverse event — any unintended and undesirable outcome that occurs as a result of medical intervention — in hospitals. Falls are often preventable and healthcare team members must work together to minimize risk factors.
A patient’s death or serious injury from a fall is considered a “Never Event.” Established by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act, a Never Event is a preventable medical error that should never occur during the course of treatment. CMS has taken steps to address Never Events — and its policies have financial implications. Healthcare facilities may be penalized by receiving reduced reimbursements based on the occurrence of patient harm events.
Which Patients Are a Fall Risk?
Factors like mobility challenges, medication use, and mental status can affect a person’s ability to move around safely in the healthcare setting. The majority of falls occur in elderly patients, particularly those who have impaired mobility or who are experiencing delirium. However, patients in hospitals can be at an increased risk due to physical and mental limitations and environmental factors. These include but aren’t limited to:
- A patient’s use of assistive devices.
- The presence of lines, tubes, and drains.
- Side effects from medication.
- Impaired judgment.
- Cognitive impairment from an injury.
The Morse Fall Risk Assessment Tool can streamline these risk factors to alert healthcare providers about a patient’s potential to fall. By taking all of these factors into consideration, healthcare providers can assess a patient’s risk and take precautions to protect their safety.
What Is the Morse Fall Scale?
A fall risk scale is an assessment tool that can be used in hospitals and post-acute care settings. They’re often part of a greater strategy to identify risks and prevent patient harm. When integrating one at your facility, you may choose from various fall risk assessment scales such as:
- Johns Hopkins Fall Risk Assessment Tool
- Hendrich II Fall Risk Model
- Morse Fall Scale
- Timed Up and Go test (TUG)
- Dynamic Gait Index
- Conley Scale
The Morse Fall Risk Scale is used to predict a patient’s likelihood of falling by evaluating individual risk factors, which fall under six categories:
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|
|
|---|---|
| 1. History of previous falls | Whether or not someone has fallen before |
| 2. Secondary diagnosis | The presence of another condition other than the admitting diagnosis |
| 3. IV therapy/ Heparin lock | The presence of an intermittent-use IV or continuous IV fluids |
| 4. Ambulatory aid | Use of assistive devices like a walker or crutches |
| 5. Gait | Ability to walk or move around in the room |
| 6. Mental status | Ability to follow directions and judge limitations |
How Is the Morse Score for Fall Risk Calculated?
The first step to calculating a fall score is by completing the Morse Fall Risk Assessment Tool.
Once the form has been completed, the total score is calculated to determine the fall risk of the patient. The Morse Fall Scale total score is calculated on a scale from 0 to 125.
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|
|
|---|---|
| Morse Fall Score | Risk Level |
| 0-24 | No or low risk |
| 25-45 | Moderate Risk |
| 45-125 | High Risk |
The tool signals nurses to consider a patient’s risk and incorporate prevention strategies in their individualized care plan. Your facility should advise clinical staff about Morse Fall Scale interventions, or action steps for patients with an identified risk.
How to Implement a Fall Risk Tool at Your Facility
Implementing a fall risk assessment tool promotes early identification of high-risk patients and may reduce the number of falls at your facility. Any risk assessment tool should be used in conjunction with nursing clinical judgment, policies, and procedures as part of a risk reduction strategy.
It’s important to note that the choice of a fall risk assessment tool may vary from one healthcare facility to another, and there isn’t a right or wrong scale to use. You may use a combination of tools to develop needs assessments tailored to your patient population. Below are steps to take when incorporating a fall risk tool at your facility.
1. Establish Fall Prevention Committees
Depending on the size of your healthcare institution, consider creating one or more shared governance committees in charge of managing fall prevention strategies. You might choose to have representatives from each unit serve as Fall Risk Champions to discuss the needs of their patient population. The purpose of the committee is to collaborate and establish a Fall Prevention Bundle, which may include prevention strategies like:
- Safety huddles
- Hourly rounding
- Morse Scale use
- Individualized interventions
- Post-fall debriefs
2. Create a Policy Guide
Next, healthcare leaders should create a policy guide for staff explaining the rationale and indications for elements of the fall risk bundle. Consider including guidance on:
- How often to perform a fall risk assessment.
- Suggested interventions based on fall risk.
- Morse Scale documentation protocol.
3. Incorporate a Flowsheet
Once your organization decides which fall risk assessment tool to incorporate into the nursing workflow, decide how it will be documented. One example is having a flowsheet embedded in the nursing shift assessment. The flowsheet may also include a place for nurses to document fall-prevention interventions taken, such as:
- Side rails up
- Bed alarm on
- No-slip socks on
- Adequate lighting
- Call bell within reach
- Sitter at bedside
Keep in mind that flowsheets may need to be customized for different departments of your healthcare facility. For example, the Morse Scale may not be appropriate for the pediatric population. Consider integrating the Little Schmidy Fall Scale for pediatric units instead.
4. Provide Staff Education
Finally, provide education to nurses about the use of the fall risk assessment tool. Education can be customized based on the nature of each nursing unit. Include items from the policy guide such as Morse Fall Scale score interpretation guidelines. Be sure to mention the importance of manipulating elements of a patient’s room design — like bed height and table location — to limit a patient’s risk for falls.
Want More Ways to Promote Patient Safety?
Your healthcare organization can take an important step toward improving patient outcomes by implementing a fall risk assessment tool like the Morse Fall Scale. Get more smart ways to promote safety at your facility with IntelyCare’s free facility newsletter.