How often should I do Morse Fall Scale? Your guide to frequency

According to the CDC, over 36 million falls are reported among older adults each year, making fall risk assessment a vital part of senior care. The question, 'how often should I do Morse Fall Scale,' is crucial for ensuring proactive and effective patient safety.

Quick Summary

The Morse Fall Scale should be performed upon admission, at every shift change, after any change in patient status, and following a fall to provide a continuous and accurate assessment of fall risk.

Key Points

• Frequency depends on patient status: Conduct the Morse Fall Scale upon admission, at every shift change, and whenever a patient's condition changes, rather than on a fixed schedule.

• Immediate reassessment after a fall: Always perform a new MFS assessment immediately after a patient falls, as this event signifies an increased risk.

• Continuity of care is key: Regular assessments, especially during shift handoffs and patient transfers, ensure the entire care team is aware of the patient's current fall risk.

• Involves six components: The scale evaluates history of falls, secondary diagnoses, ambulatory aids, IV/heparin lock, gait, and mental status to create a comprehensive risk profile.

• Not a static tool: The Morse Fall Scale score is dynamic, reflecting the patient's ever-changing health status and requiring frequent re-evaluation to be effective.

What is the Morse Fall Scale (MFS)?

The Morse Fall Scale (MFS) is a rapid and simple tool used by healthcare professionals to assess a patient's risk of falling. It is a six-item scale that scores a patient's risk factors, including history of falls, secondary diagnoses, ambulatory aids, IV/saline lock, gait, and mental status. The total score helps determine the appropriate level of intervention required to prevent falls.

The Six Components of the MFS

1. History of Falls: A history of a recent fall or falls within the last three months increases the risk of future falls.
2. Secondary Diagnosis: Having more than one medical diagnosis can indicate a higher risk due to more complex health needs and potential drug interactions.
3. Ambulatory Aids: Needing or using devices like crutches, canes, or a walker affects mobility and balance.
4. Intravenous Therapy/Heparin Lock: Having an IV or heparin lock can hinder mobility and create a tripping hazard.
5. Gait: An unsteady or impaired gait (the way a person walks) is a primary risk factor for falls.
6. Mental Status: A patient's judgment and awareness of their surroundings are critical to fall prevention. Factors like disorientation, overestimating abilities, or memory impairment can increase risk.

Establishing the correct frequency for MFS

Understanding how often to conduct the Morse Fall Scale is essential for creating a proactive and effective fall prevention strategy. The frequency is not a one-size-fits-all rule but depends on various factors related to the patient's condition and care setting.

Key Moments for Reassessment

• On Admission: A baseline assessment must be conducted upon a patient's admission to a healthcare facility. This establishes their initial fall risk and informs the creation of an initial care plan.
• With Every Nursing Shift Change: Patient conditions can change rapidly. Reassessing the MFS at each nursing shift handover ensures that the new care team is aware of the patient's current risk level and can take appropriate precautions.
• Upon a Change in Patient Status: Any significant change in a patient's medical condition warrants an immediate re-evaluation. This includes, but is not limited to, changes in medication, new symptoms, or a decline in cognitive function.
• After a Fall Event: If a patient experiences a fall, even without injury, a new MFS assessment is critical. A fall is a strong predictor of future falls and a reassessment can help identify new or exacerbated risk factors.
• Upon Transfer or Discharge: When a patient is transferred to another unit or discharged to a different setting (e.g., from an acute care hospital to a rehabilitation facility), a final assessment should be conducted to ensure a seamless and safe transition.

Why continuous assessment is vital

Continuous assessment is a cornerstone of patient safety. Fall risk is not static; it can fluctuate based on a patient's pain level, medication side effects, or a developing illness. Regular and timely reassessment using the MFS allows healthcare providers to quickly adapt intervention strategies, such as adding assistive devices or increasing supervision, thereby reducing the likelihood of a fall.

The MFS in different care settings

While the fundamental principles remain the same, the specific application of the Morse Fall Scale can differ slightly across various care environments. For instance, in an acute care hospital, where patients often have rapidly changing conditions, daily or even more frequent assessments are common. In a long-term care or residential facility, where residents' conditions are more stable, reassessment might occur quarterly or annually, in addition to after a significant change in status.

Feature	Acute Care Setting	Long-Term Care Setting
Frequency	Upon admission, every shift change, after a fall, with status change.	Upon admission, after a fall, with status change, and at least annually.
Patient Conditions	Often dynamic, with rapid changes due to acute illness, surgery, or new medications.	Generally more stable, though chronic conditions can lead to gradual decline.
Interventions	Frequently adjusted, may involve closer monitoring, bed alarms, or physical therapy.	Consistent care plans, often focusing on long-term strength and balance training.
Goal	Prevent falls during a short, intensive period of care.	Maintain a safe environment and functional ability over an extended period.

Implementing a successful fall prevention program

Using the Morse Fall Scale effectively is just one part of a comprehensive fall prevention program. An organization-wide approach that includes staff education, a multidisciplinary team, and tailored interventions is key to success. A successful program not only identifies patients at risk but also empowers staff to take decisive action.

Practical steps for implementation

• Educate Staff: Ensure all healthcare staff are properly trained on how to administer the MFS accurately and what the scores mean. This includes nurses, therapists, and patient care assistants.
• Tailor Interventions: Interventions should be personalized based on the MFS score. For example, a patient with a high score might need a bed alarm, while a lower-risk patient might simply need a non-slip mat in the shower.
• Promote a Safety Culture: Encourage all staff to report any observed risk factors, such as a patient showing an unsteady gait, regardless of the most recent MFS score.
• Engage Patients and Families: Educate patients and their families about fall risks and prevention strategies. A collaborative approach improves compliance and awareness. For example, involving the family in decluttering a resident's room in a long-term care setting can be helpful.

Conclusion

The Morse Fall Scale is a cornerstone of proactive fall prevention in healthcare settings, but its effectiveness relies heavily on its correct and consistent application. By conducting the assessment not just periodically, but at critical junctures such as admission, during shift changes, and following any patient status change or fall, healthcare teams can ensure patient safety is a continuous priority. This dynamic approach ensures that interventions are always tailored to the patient's current risk level, ultimately leading to better outcomes for senior care. For more information on patient safety, consult reputable resources like the Agency for Healthcare Research and Quality.

Frequently Asked Questions

Who should be assessed using the Morse Fall Scale?

The Morse Fall Scale is used for patients in healthcare settings, including hospitals and long-term care facilities. It is typically used for all adult patients to identify those at risk of falling and to implement appropriate preventive measures.

What is considered a high-risk score on the MFS?

A total score of 45 or higher on the Morse Fall Scale typically indicates a high risk for falling. Healthcare facilities use these scores to trigger specific fall prevention protocols, such as using bed alarms or closer supervision.

How do you score the Morse Fall Scale?

The MFS is scored by adding up the points assigned to each of the six risk factors. The higher the total score, the greater the patient's risk of falling. Training modules are available for healthcare professionals to ensure accurate scoring.

Can the Morse Fall Scale be used at home for seniors?

While the Morse Fall Scale is designed for professional use in clinical settings, its principles are relevant. However, for a home environment, a healthcare provider or physical therapist is better equipped to conduct a home safety assessment and recommend modifications for fall prevention.

What interventions are based on the Morse Fall Scale?

Based on the MFS score, interventions can include implementing bed alarms, ensuring non-slip footwear, providing assistive devices, increasing staff rounds, and educating the patient and family about the identified risks.

Is the Morse Fall Scale the only fall risk assessment tool?

No, other tools exist, such as the Hendrich II Fall Risk Model and the Johns Hopkins Fall Risk Assessment Tool. The MFS is one of the most widely used tools, but the specific tool depends on the healthcare facility's policy and patient population.

What is the primary purpose of the Morse Fall Scale?

The primary purpose of the Morse Fall Scale is to systematically identify patients at risk for falling so that healthcare providers can implement proactive and preventative measures to enhance patient safety and reduce fall-related injuries.