Ask the care expert ... about the Morse Fall Scale

Share this article:
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

What is the Morse Fall Scale, and how it is different from others?

Nursing fall-risk assessment, diagnoses and interventions are based on use of the Morse Fall Scale. 

The MFS requires systematic, reliable assessment of a patient's fall risk factors upon admission and upon falls, change in status and discharge or transfer to a new setting. MFS subscales include assessment of: history of falls (immediate or within 3 months), secondary diagnosis, ambulatory aid, IV/heparin lock, gait/transferring, and mental status. 

When a score is obtained and it is either low or high, there are certain medical factors Morse tells the nursing staff to look at, such as: 

- Agitation/Delirium: infection, toxic/metabolic, cardiopulmonary change, CNS, dehydration/ blood loss, sleep disturbance

- Meds (dose/timing): psychotropics, CV agents (digoxin especially), anticoagulants (increased risk of injury), anticholinergic, bowel prep

- Orthostatic hypotension, autonomic failure

- Frequent toileting

- Impaired mobility

- Impaired vision, inappropriate use of assistive device/footwear

Identifying these factors, and asking basic questions such as whether the resident is in pain, will help nurses with interventions and creating a care plan.  

More acute care providers might be using the Morse Fall Scale than long-term care providers, but with more IVs and sicker, frailer residents being cared for in long-term care, Morse could be a good fit for your facilities, too. 

Please remember to change your facility's policies if you are making changes to the assessments required of the staff. 

Share this article:

More in News

Proposed managed care rule could accelerate shift away from nursing home care, official suggests

Proposed managed care rule could accelerate shift away ...

Proposed regulations slated for early 2015 likely will affect how Medicaid managed care balances home- versus facility-based long-term care, news sources reported Wednesday.

Assisted living residents say 'homelike' setting not so important

Contrary to conventional wisdom, assisted living residents might not place a high value on how "homelike" their surroundings are, suggest findings out of St. Catherine University in St. Paul, MN.

Adjust residents' hearing aids before they listen to music, researcher advises

Nursing home residents might get more enjoyment and therapeutic value out of music if they change hearing aid settings, recently published findings suggest.