What is the difference between Morse fall risk assessment tool and the Johns Hopkins fall risk assessment tool?

According to the CDC, over 14 million Americans age 65+ fall each year. When assessing fall risk, healthcare professionals often use standardized tools, and understanding what is the difference between Morse fall risk assessment tool and the Johns Hopkins fall risk assessment tool is critical for effective prevention in senior care settings.

Quick Summary

The primary difference lies in their complexity and focus: the Morse tool is a simpler, quicker assessment focused on six factors, while the Johns Hopkins tool is more comprehensive, incorporating additional items like medication and equipment ideal for acute care.

Key Points

• Complexity and Detail: The Morse Fall Scale is simpler and quicker to administer, using six core factors. The Johns Hopkins Fall Risk Assessment Tool is more detailed and comprehensive, incorporating additional items like medication and equipment.

• Setting and Acuity: JHFRAT is shown to be more effective in reflecting the rapidly changing conditions of acute care hospital settings. The MFS is versatile and widely used across various care environments, including long-term and rehabilitative care.

• Scoring and Risk Thresholds: Both tools categorize risk into low, moderate, and high, but use different point values and criteria. MFS scores range from 0-125+, while JHFRAT scores range from 0-35.

• Factors Assessed: MFS focuses on a history of falls, secondary diagnosis, ambulatory aid, IV therapy, gait, and mental status. JHFRAT includes age, history, elimination, medications, equipment, mobility, and cognition.

• Implementation: The simpler MFS is often favored for ease of use and speed, while the more thorough JHFRAT provides a deeper risk profile, particularly useful for complex patients with multiple risk factors.

• Action Beyond Assessment: Both tools are only the first step. The ultimate goal is to use the assessment results to inform and implement targeted, patient-specific interventions to prevent falls.

Understanding the Morse Fall Risk Assessment Tool

The Morse Fall Scale (MFS) is one of the most widely used and well-known fall risk assessment tools in healthcare. Developed for rapid, easy application, it relies on a simple scoring system based on historical data and observable patient characteristics. Its widespread use across various care settings is a testament to its practical nature and ease of implementation.

Components of the Morse Fall Scale

The MFS evaluates six specific variables to determine a patient's fall risk, with points assigned to each characteristic. The higher the total score, the greater the patient's assessed risk.

1. History of Falling: A score of 25 points is assigned if the patient has a recent history of falls, either in the current admission or within the immediate past.
2. Secondary Diagnosis: If the patient has more than one medical diagnosis, 15 points are added. This accounts for the potential impact of multiple health issues on stability and overall health.
3. Ambulatory Aid: Points are assigned based on the type of aid the patient uses. A score of 0 is for no aid/bed rest, 15 points for using crutches/cane/walker, and 30 points if the patient relies on furniture or another person for assistance.
4. IV or Heparin Lock: The presence of an intravenous line or heparin lock adds 20 points, as it can affect mobility and create a tripping hazard.
5. Gait: The patient's walking ability is assessed. A normal gait is 0 points, a weak gait (stooped, unsteady) is 10 points, and an impaired gait (difficulty rising from chair, unable to walk without assistance) is 20 points.
6. Mental Status: This assesses the patient's awareness of their limitations. A patient who is aware of their ambulation issues and capabilities scores 0 points, while one who overestimates their ability or is confused scores 15 points.

Scoring and Risk Levels for the Morse Tool

After summing the points from the six categories, the patient is assigned a risk level based on the total score:

• Low Risk (0-24 points): Standard fall prevention interventions are implemented.
• Moderate Risk (25-45 points): A higher level of vigilance and specific fall prevention strategies are employed.
• High Risk (46+ points): The patient is considered at high risk of falling, and comprehensive prevention protocols are put in place.

Understanding the Johns Hopkins Fall Risk Assessment Tool

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) offers a more comprehensive and detailed evaluation, particularly useful in acute care settings where a patient's condition can change rapidly. It is designed to capture a wider range of risk factors that influence patient safety during a hospital stay.

Components of the Johns Hopkins Fall Risk Tool

The JHFRAT includes a pre-screener and seven main assessment areas, with each item assigned a specific point value. The tool allows clinicians to capture a more nuanced picture of a patient's risk profile.

1. Age: Older adults are given higher scores, reflecting the increased risk associated with age.
2. Fall History: Similar to the MFS, a history of falls is a strong predictor and factored into the score.
3. Elimination (Bowel & Urine): Frequent or urgent elimination needs can increase fall risk due to increased mobility and urgency demands.
4. Medications: High-risk medications, such as sedatives, diuretics, and antihypertensives, are specifically listed and scored.
5. Patient Care Equipment: This assesses for any equipment tethering the patient, such as an IV line, Foley catheter, or oxygen tubing, which can pose a tripping hazard.
6. Mobility: The patient's ability to walk, transfer, and use assistive devices is evaluated in detail.
7. Cognition: This assesses the patient's mental status, including awareness, orientation, and ability to follow instructions.

Scoring and Risk Levels for the Johns Hopkins Tool

Following the assessment, a total score is tallied to categorize the patient's risk level:

• Low Risk (<6 points)
• Moderate Risk (6-13 points)
• High Risk (>13 points)

Comparison: Morse vs. Johns Hopkins

The most significant distinction between the two tools lies in their scope, focus, and clinical application. The Morse tool offers speed and simplicity, while the Johns Hopkins tool provides greater detail, making it more sensitive to the dynamic changes in an acute care environment.

Feature	Morse Fall Risk Assessment Tool (MFS)	Johns Hopkins Fall Risk Assessment Tool (JHFRAT)
Number of Items	6	7 (plus initial screener)
Key Focus Areas	History, diagnosis, aids, IV, gait, mental status	Age, history, elimination, medications, equipment, mobility, cognition
Scoring	0-125+ points	0-35 points
Complexity	Simpler, quicker assessment	More comprehensive, detailed assessment
Ideal Setting	Versatile; widely used across acute, long-term, and rehab care	Particularly effective in acute care where patient status changes rapidly
Predictive Accuracy	Good predictive validity and inter-rater reliability	Proven to be more accurate in reflecting acute changes and predicting falls in acute care settings
Specificity	Lower specificity than JHFRAT in acute settings	Higher specificity for predicting falls in acute care

How to Choose the Right Fall Risk Assessment Tool

Selecting the appropriate fall risk tool depends heavily on the healthcare environment and the patient population. Here are some key considerations for choosing between the Morse and Johns Hopkins tools:

• Patient Acuity: In high-acuity settings like hospitals, where a patient’s condition and medication regimen can change frequently, the JHFRAT's comprehensive nature and focus on changeable conditions can be more effective for anticipating risk.
• Efficiency: The MFS's simplicity and speed make it an excellent choice for a variety of settings where a quick, reliable assessment is needed without extensive training or time commitment. It's often favored for its ease of use.
• Patient Population: For complex patients with multiple comorbidities, the JHFRAT's ability to factor in medication and equipment adds valuable depth to the assessment. The MFS may still be appropriate, but additional clinical judgment might be required.
• Resource Availability: The JHFRAT requires more time and training for staff to complete thoroughly due to its detailed components. The MFS, being more straightforward, can be more easily integrated into busy clinical workflows.

Actionable Steps Beyond Assessment

No fall risk tool, regardless of its accuracy, can replace vigilant, hands-on care and a robust fall prevention program. An assessment tool is merely the first step. Based on the risk identified, healthcare teams must implement targeted, evidence-based interventions to protect patient safety. These interventions may include:

• Environmental Modifications: Keeping walkways clear of clutter, ensuring adequate lighting, and providing grab bars in bathrooms.
• Assistive Devices: Ensuring patients have and properly use devices like walkers or canes.
• Medication Review: Conducting regular reviews of a patient's medication list to identify drugs that could increase fall risk.
• Mobility Assistance: Providing supervised assistance with ambulation and transfers, especially for high-risk patients.
• Patient and Family Education: Informing patients and their families about fall risks and prevention strategies they can use.

For more resources on fall prevention and an easy-to-use online screening tool, visit the National Council on Aging's Falls Free CheckUp.

Conclusion

While both the Morse and Johns Hopkins fall risk tools are effective for identifying at-risk patients, the key difference lies in their scope and clinical focus. The MFS is praised for its quick, simple assessment across many care settings, while the JHFRAT offers a more detailed, comprehensive evaluation, making it highly effective for reflecting the changeable conditions of an acute care environment. Choosing the right tool depends on the specific clinical needs and patient population, but both serve as invaluable starting points for implementing robust fall prevention strategies that protect patient health and well-being. Ultimately, the assessment's value is realized through the subsequent protective interventions that are put in place.

Frequently Asked Questions

Which fall risk tool is better for acute care: Morse or Johns Hopkins?

Studies suggest that the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is more effective for acute care settings because it more accurately reflects changeable conditions related to fall risk after admission.

What are the six factors assessed by the Morse Fall Scale?

The Morse Fall Scale assesses a patient's history of falling, the presence of a secondary diagnosis, use of ambulatory aids, whether they have an IV or heparin lock, their gait, and their mental status.

How is the Johns Hopkins Fall Risk Assessment Tool different from the Morse tool?

The Johns Hopkins tool is more comprehensive, including factors like age, specific high-risk medications, and tethering equipment. The Morse tool is simpler and faster, focusing on broader categories.

What is considered a high risk for falls using the Morse Fall Scale?

A patient is typically considered at high risk for falling if their total score on the Morse Fall Scale is 46 points or higher.

What are the components of the Johns Hopkins Fall Risk Assessment Tool?

The JHFRAT assesses age, fall history, elimination (bowel and urine), medications, patient care equipment, mobility, and cognition.

Can the Morse Fall Scale be used in long-term care settings?

Yes, the Morse Fall Scale is widely used and validated for application across multiple settings, including acute, long-term, and rehabilitative care.

How do you interpret the scores of the Johns Hopkins Fall Risk Assessment Tool?

A score of less than 6 indicates a low fall risk, 6-13 indicates a moderate risk, and greater than 13 points indicates a high fall risk.