What are the fall risk assessment tools in hospitals?

According to the Centers for Disease Control and Prevention, fall-related injuries in a single year contributed to over $50 billion in medical costs. To combat this significant patient safety issue, healthcare professionals use various standardized instruments known as fall risk assessment tools in hospitals to identify and mitigate a patient's risk of falling. These tools are an essential component of comprehensive fall prevention programs.

Quick Summary

This guide outlines the purpose and methodology of standard fall risk assessment tools used in hospitals, including the Morse Fall Scale, Hendrich II Fall Risk Model, and the Johns Hopkins Fall Risk Assessment Tool. It explains how these validated scales help clinicians identify at-risk patients and implement tailored interventions to reduce the likelihood of in-hospital falls.

Key Points

• Morse Fall Scale: This tool quickly assesses fall risk using six key variables, including fall history, gait, and mental status, and is widely used in acute care.

• Hendrich II Fall Risk Model: Developed for acute care, this model identifies eight specific risk factors to guide targeted interventions beyond just assigning a risk score.

• Johns Hopkins Fall Risk Assessment Tool (JHFRAT): The JHFRAT provides a comprehensive assessment covering factors like age, medications, and mobility to inform personalized safety interventions.

• Performance-Based Tests: Simple, fast physical tests like the Timed Up and Go (TUG), 30-Second Chair Stand, and 4-Stage Balance tests can screen for mobility and balance issues.

• Multifactorial Approach is Key: The most effective fall prevention strategy combines risk assessment tools with a review of patient medications, environmental factors, and individualized interventions.

• Assess at Key Intervals: Fall risk should be assessed on admission, with any change in condition, upon transfer to a new unit, and following a fall event.

Common Fall Risk Assessment Tools

Hospitals employ several evidence-based fall risk assessment tools to proactively enhance patient safety. These tools differ in their criteria and scoring, categorizing a patient's risk from low to high. The chosen tool often aligns with the hospital's specific clinical environment and patient population.

The Morse Fall Scale (MFS)

The Morse Fall Scale (MFS) is a widely adopted and straightforward tool for assessing fall likelihood. It uses six variables to quickly score a patient's risk, guiding appropriate interventions.

The six variables of the MFS include:

• History of falling within the last three months.
• Presence of a secondary diagnosis.
• Use of an ambulatory aid.
• Presence of an intravenous line (IV) or heparin lock.
• Type of gait (normal, weak, or impaired).
• Mental status (oriented to abilities or forgets limitations).

The Hendrich II Fall Risk Model

Validated for acute care, the Hendrich II Fall Risk Model focuses on interventions for specific risk factors rather than a cumulative score. It evaluates eight factors, such as mental status, medications, dizziness, and a mobility test. Details about the specific risk factors in the Hendrich II Model can be found on {Link: ScienceDirect.com https://www.sciencedirect.com/science/article/pii/S0897189719306214}.

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT)

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is a comprehensive assessment for adult patients. It starts with a screener and progresses to a more detailed assessment if risk is unclear.

The JHFRAT considers risk factors like:

• Age.
• Fall history.
• Bowel and bladder elimination.
• Medications.
• Patient care equipment (e.g., IVs or catheters).
• Mobility.
• Cognition.

Other Assessment Tools and Tests

Hospitals may also use simpler performance-based tests to assess balance and mobility, either as a quick screen or part of a larger assessment.

• Timed Up and Go (TUG) Test: Measures time to stand, walk, turn, and sit. A time over 12 seconds indicates high fall risk.
• 30-Second Chair Stand Test: Counts stands in 30 seconds to assess leg strength.
• 4-Stage Balance Test: Evaluates static balance by holding increasingly difficult stances.

Comparison of Fall Risk Assessment Tools

Feature	Morse Fall Scale (MFS)	Hendrich II Fall Risk Model	Johns Hopkins Fall Risk Assessment Tool (JHFRAT)
Primary Goal	Provides a rapid, easy-to-use scoring method to categorize patients as low, medium, or high risk.	Focuses on addressing specific risk factors with targeted interventions, moving beyond a single risk score.	Offers a comprehensive, multi-component assessment designed to inform safety interventions.
Variables	6 variables: Fall history, secondary diagnosis, ambulatory aid, IV/heparin lock, gait, mental status.	The Hendrich II Model evaluates 8 factors, detailed on {Link: ScienceDirect.com https://www.sciencedirect.com/science/article/pii/S0897189719306214}.	7 factors: Age, fall history, elimination, medications, equipment, mobility, and cognition.
Setting	Acute and long-term care settings.	Primarily developed and validated for acute care settings.	Primarily used in hospital settings.
Scoring	Points assigned to each category to calculate a total score.	Scores based on the presence of specific risk factors and the mobility test result.	A point-based system that stratifies patients based on an initial screener and further assessment.
Interventions	Guides general fall prevention strategies based on risk category.	Maps risk factors to specific, evidence-based interventions. Details are available on {Link: ScienceDirect.com https://www.sciencedirect.com/science/article/pii/S0897189719306214}.	Informs appropriate interventions based on assessment findings.

Best Practices for Using Assessment Tools

Effective hospital fall prevention involves assessing risk, creating a personalized plan, and consistent execution. Proper use of assessment tools is crucial.

When to Perform a Fall Risk Assessment

Fall risk can change during a hospital stay, necessitating assessments at key times:

• On admission: For a baseline risk.
• Upon transfer: Moving units changes risk.
• Following a fall: Essential to update the care plan.
• With changes in condition: Adjustments in health or treatment impact risk.
• Routinely: Often done at the start of each nursing shift.

The Importance of a Multifactorial Approach

Multifactorial assessments combined with appropriate interventions are most effective in reducing falls. This involves considering various factors:

• Patient factors: Including gait, balance, muscle strength, vision, continence, cognition, and fall history.
• Medication review: Identifying and addressing high-risk medications.
• Environmental factors: Ensuring proper lighting, clear pathways, non-slip footwear, and assistive devices.
• Patient and family education: Involving patients and families in prevention strategies.

Conclusion

Fall risk assessment tools are vital for identifying at-risk hospital patients. Tools like the Morse Fall Scale, Hendrich II Fall Risk Model, and functional tests provide a framework for decision-making. Their effectiveness is maximized within a dynamic, multifactorial fall prevention program that includes continuous monitoring, personalized interventions, and patient/family engagement. By evaluating patient and environmental factors, hospitals can significantly lower fall incidence and improve safety. For more resources, the Agency for Healthcare Research and Quality (AHRQ) offers toolkits like Fall TIPS.

Frequently Asked Questions

What is the primary purpose of a fall risk assessment tool in a hospital?

The primary purpose is to systematically identify hospitalized patients who are at a higher risk of falling, allowing healthcare staff to implement targeted preventive interventions to ensure patient safety and reduce fall-related injuries.

Which is the most commonly used fall risk tool in hospitals?

The Morse Fall Scale (MFS) is one of the most widely used fall risk assessment tools due to its simplicity and efficiency. It uses a quick scoring system to classify patients as low, medium, or high risk.

How often should a patient's fall risk be assessed in the hospital?

A patient's fall risk should be assessed on admission, upon transfer between units, after any fall incident, and whenever there is a significant change in the patient's condition, such as a new medication or cognitive decline.

Can fall risk assessment tools predict all falls?

No. While these tools are effective at identifying many common risk factors, they cannot predict all falls, especially those caused by unexpected physiological events. The tools should be used as part of a broader, continuous vigilance strategy.

What happens after a patient is identified as high-risk for falls?

After a patient is identified as high-risk, staff will implement specific, evidence-based interventions tailored to the individual's needs. This may include patient education, providing non-slip footwear, ensuring a clear environment, and using assistive devices.

Is age the only factor considered in a fall risk assessment?

No, age is not the sole factor in fall risk assessments. While older patients are at a higher risk, most tools incorporate a range of factors including mobility, mental status, medications, and medical conditions to provide a more accurate and holistic evaluation.

What is the difference between a functional test and a risk assessment scale?

Functional tests, such as the Timed Up and Go (TUG), measure a patient's current physical ability, like balance and mobility. Risk assessment scales, like the Morse Scale, use a combination of factors, including medical history and physical status, to provide a comprehensive prediction of fall risk.