What are the fall scales used in hospitals?

According to the CDC, one in four older adults falls each year, making fall prevention a critical component of inpatient care. To systematically evaluate a patient's risk and implement targeted interventions, healthcare facilities rely on specific, evidence-based tools. A clear understanding of what are the fall scales used in hospitals is essential for both clinicians and patient families seeking to ensure a safer recovery.

Quick Summary

Several validated fall scales are used in hospitals to assess a patient's risk, including the Morse Fall Scale, Hendrich II Fall Risk Model, and the Johns Hopkins Fall Risk Assessment Tool, among others. These tools help staff identify individuals at higher risk of falling, allowing for the implementation of customized preventive measures to enhance patient safety during their hospital stay.

Key Points

• Standardized Assessment: Hospitals use validated fall scales like the Morse, Hendrich II, and Johns Hopkins tools to consistently evaluate a patient's risk of falling.

• Multi-Factor Evaluation: These scales assess a variety of risk factors, including a patient's medical history, mental status, gait, medication use, and need for assistive devices.

• Personalized Interventions: Based on the fall risk score, nurses and other healthcare professionals implement a tailored plan of interventions to reduce the likelihood of a fall.

• Promoting Patient Safety: The systematic use of fall scales is a cornerstone of patient safety protocols, helping to prevent potentially serious injuries and improve patient outcomes.

• Continuous Monitoring: Patients are reassessed for fall risk at key points during their hospital stay, such as upon admission, after a change in condition, or when transferring units, to ensure interventions remain appropriate.

Common Fall Scales Used in Clinical Practice

Fall risk assessment is a standard procedure upon admission to a hospital, following a transfer to a new unit, or after a significant change in a patient's condition. By using standardized screening tools, nurses can quickly and consistently identify risk factors and tailor a care plan accordingly. The scales collect data on various patient-specific factors, such as mobility, medication use, mental status, and medical history.

Morse Fall Scale (MFS)

The Morse Fall Scale is one of the most widely used and validated tools for adult inpatients. It is recognized for its speed and ease of use, and a large majority of nurses rate it as quick and simple to implement. The scale consists of six variables, with each item assigned a numerical score.

The six components of the MFS are:

• History of falling: Previous fall within three months.
• Secondary diagnosis: More than one medical diagnosis.
• Ambulatory aid: The type of device used for walking, if any.
• IV/Heparin lock: The presence of an intravenous line.
• Gait: The patient's walking ability (normal, weak, or impaired).
• Mental status: The patient's orientation and ability to follow instructions.

The total score is calculated, and based on the result, a patient is classified as low, medium, or high risk for falls.

Hendrich II Fall Risk Model

Designed for the adult patient population in acute care settings, the Hendrich II Fall Risk Model was developed to help predict the likelihood of falls in this specific environment. It focuses on eight independent risk factors and is known for its strong predictive validity. This model is also considered simple and quick for clinical staff to administer.

The eight components of the Hendrich II model include:

• Confusion/Disorientation/Impulsivity
• Symptomatic Depression
• Altered Elimination (e.g., frequent toileting needs, incontinence)
• Dizziness/Vertigo
• Gender (male patients receive a score)
• Antiepileptics
• Benzodiazepines
• Get Up and Go Test (observes the patient's ability to rise from a chair)

The combination of these factors gives a total risk score, guiding interventions like increased supervision, specific toileting schedules, or medication reviews.

Johns Hopkins Fall Risk Assessment Tool (JHFRAT)

The JHFRAT is another comprehensive tool that provides a multi-faceted approach to fall risk. It is used to assess a patient's risk based on several criteria, offering a more holistic view of the patient's situation.

Key factors assessed by the JHFRAT include:

• Age
• Fall history
• Specific medications
• Mobility status
• Cognitive and behavioral status
• Elimination

This tool is particularly useful for identifying the underlying reasons for a patient's fall risk and helps the healthcare team address those factors directly.

Other Notable Scales

While MFS, Hendrich II, and JHFRAT are very common, other specialized scales exist. For example, the Humpty Dumpty Fall Scale is widely used in pediatric care to assess fall risk in children, and the STRATIFY tool (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients) is another option, though perhaps less common than the MFS in U.S. hospitals. For a visual or functional assessment, a simple Timed Up and Go (TUG) test can also provide useful information about a patient's mobility and balance.

Comparison of Major Fall Risk Scales

Different scales may be preferred in certain clinical settings or for specific patient populations. Here is a comparison of three major fall scales used in hospitals to highlight their key differences.

Feature	Morse Fall Scale (MFS)	Hendrich II Fall Risk Model	Johns Hopkins Fall Risk Assessment Tool (JHFRAT)
Target Population	Adult inpatients (medical, surgical, rehabilitation)	Adult inpatients (acute care)	Adult inpatients across various hospital units
Assessment Items	6 variables	8 independent risk factors, including medications	7-item assessment, with points based on patient risk factors
Focus	Quick, straightforward assessment of observable risk factors	Emphasis on physiological and medication-related risks	Comprehensive, multi-faceted assessment for a holistic view
Considered Factors	History of falls, diagnosis, ambulatory aid, IV, gait, mental status	Confusion, depression, elimination, dizziness, gender, specific medications	Age, fall history, medications, mobility, cognitive status
Administration	Quick to score and implement	Fast and easy to use	Can be more detailed, providing a broader picture

Implementation and Interventions

Once a patient's fall risk is assessed using one of these scales, the next step is to implement a personalized care plan. Interventions are crucial for mitigating risk and preventing injury. The specific interventions will depend on the identified risk factors, and may include:

1. Environmental modifications: Keeping the bed in a low position, ensuring the call light is within reach, and decluttering the room.
2. Increased supervision: Providing bed alarms or assigning a safety companion for high-risk patients.
3. Medication management: Reviewing and adjusting medications that may cause dizziness, drowsiness, or orthostatic hypotension.
4. Assisted mobility: Providing and properly utilizing assistive devices like canes or walkers.
5. Patient and family education: Informing the patient and family about the fall risk and prevention strategies.

For more information on effective fall prevention strategies in healthcare settings, the Agency for Healthcare Research and Quality (AHRQ) provides valuable resources.

Conclusion

Standardized fall scales are a foundational tool for patient safety in hospital settings. By providing a consistent and evidence-based method for assessing risk, these tools enable healthcare professionals to identify and protect vulnerable patients. While the specific scale may vary between institutions, their core purpose remains the same: to enhance patient care by preventing falls. Understanding how these tools work and what interventions are implemented helps patients, and their families feel more secure and informed during their hospital stay.

Frequently Asked Questions

Who uses the fall scales in a hospital?

Fall scales are primarily used by nursing staff, but the results inform the entire care team, including physicians, physical therapists, and occupational therapists, who all collaborate on a patient's fall prevention plan.

How often is a fall risk assessment performed?

A fall risk assessment is typically performed upon admission to the hospital, and then repeated at regular intervals (e.g., at the beginning of each shift), following a significant change in the patient's condition, or after a transfer to a new unit.

What happens if a patient is identified as a high fall risk?

If a patient is identified as a high fall risk, the care team will implement specific interventions, which may include using bed alarms, assigning more frequent rounds, providing special footwear, and educating the patient and family on safety measures.

Can a patient's fall risk change during their hospital stay?

Yes, a patient's fall risk can change due to new medications, changes in their medical condition, surgery, or other factors. For this reason, assessments are performed regularly to ensure the care plan remains current and effective.

What is the difference between the Morse Fall Scale and the Hendrich II Fall Risk Model?

The main difference lies in their focus. The Morse Fall Scale assesses factors like history of falls and ambulatory aid, while the Hendrich II model places greater emphasis on physiological risk factors, including specific medications and symptoms like dizziness.

Is the same fall scale used for all patients?

No, different fall scales are used for different populations. For instance, while the Morse Fall Scale is common for adult inpatients, a specialized scale like the Humpty Dumpty Fall Scale is used for pediatric patients.

What role does the patient's family play in fall prevention?

Families are crucial partners in fall prevention. They are educated on the patient's risks and can help reinforce safety behaviors, such as ensuring the call light is within reach and assisting the patient when getting up.

Are there environmental factors assessed for fall risk?

While the scales focus on patient factors, environmental hazards are always considered. Interventions include ensuring the room is well-lit, free of clutter, and equipped with non-slip flooring and handrails.