Inpatient falls represent a significant challenge for healthcare facilities, ranging from hospitals to post-acute care centers. These incidents can lead to prolonged hospital stays, patient injuries, and in the most severe cases, fatalities. Healthcare providers bear the responsibility to ensure a safe environment for patients, and this includes proactive strategies to minimize the risk of falls. Fall prevention programs are essential components of patient care, often incorporating risk assessments, comprehensive staff training, and modifications to the patient environment. Among the various fall risk assessment tools available, the Morse Fall Scale stands out as a widely utilized and effective method. This article will delve into the implementation of a fall risk assessment tool, specifically focusing on the Morse Fall Scale and the critical role of secondary diagnosis in predicting patient fall risk.
A nurse helps one of her patients walk down the hallway, as he learns how to use a walker.
Alt text: A nurse attentively assists a patient using a walker in a hospital hallway, emphasizing mobility support and fall prevention in healthcare settings.
The Serious Implications of Inpatient Falls
The World Health Organization (WHO) defines a fall as “an event that results in a person coming to rest inadvertently on the ground, floor, or other lower level.” For patients already dealing with health issues, a fall can significantly worsen their condition and recovery. The statistics surrounding inpatient falls are alarming and highlight the urgency of effective prevention strategies:
Falls are the most frequently reported adverse event in hospital settings. These adverse events, defined as unintended and undesirable outcomes resulting from medical intervention, underscore the preventable nature of many falls and the necessity for collaborative teamwork among healthcare professionals to mitigate risk factors.
Furthermore, patient death or serious injury resulting from a fall is classified as a “Never Event.” The Centers for Medicare and Medicaid Services (CMS) established this category under the Affordable Care Act to denote preventable medical errors that should never occur during treatment. CMS has implemented measures to address Never Events, including financial penalties for healthcare facilities in the form of reduced reimbursements when patient harm events occur, emphasizing the financial and ethical importance of fall prevention.
Identifying Patients at Risk: The Role of Secondary Diagnosis
Various factors can compromise a patient’s ability to move safely within a healthcare environment. Mobility issues, medication side effects, and altered mental status are all significant contributors to fall risk. While falls are more prevalent among elderly patients, especially those with mobility impairments or delirium, any hospitalized patient can be at increased risk due to physical and cognitive limitations coupled with the unfamiliar hospital environment. Risk factors include, but are not limited to:
- Use of assistive devices for mobility.
- Presence of medical lines, tubes, and drains.
- Adverse effects of medications.
- Impaired judgment and decision-making.
- Cognitive deficits resulting from illness or injury.
The Morse Fall Risk Assessment Tool is designed to systematically evaluate these risk factors, providing healthcare providers with a structured method to identify patients at high risk of falling. By considering these elements, clinicians can proactively implement preventative measures tailored to each patient’s specific needs.
Deep Dive into the Morse Fall Scale: Understanding Secondary Diagnosis
A fall risk scale is a crucial assessment tool employed in hospitals and post-acute care facilities to identify patients at risk of falls. These scales are integral to broader strategies aimed at preventing patient harm. When selecting a tool for your facility, options range from the Johns Hopkins Fall Risk Assessment Tool to the Hendrich II Fall Risk Model, the Timed Up and Go test (TUG), and the Conley Scale. Among these, the Morse Fall Scale is widely recognized for its simplicity and effectiveness.
The Morse Fall Scale predicts the likelihood of a patient falling by evaluating individual risk factors across six categories. Critically, one of these categories is secondary diagnosis. According to the Agency for Healthcare Research and Quality (AHRQ), secondary diagnosis refers to the presence of any additional medical condition beyond the patient’s primary admitting diagnosis.
| Morse Fall Score Categories | Description |
|---|---|
| 1. History of previous falls | Has the patient fallen in the recent past or prior to admission? |
| 2. Secondary diagnosis | Is there more than one medical diagnosis present in addition to the primary admitting diagnosis? |
| 3. IV therapy/ Heparin lock | Is the patient receiving intravenous fluids or medications, or have a heparin lock in place? |
| 4. Ambulatory aid | Does the patient use mobility aids such as walkers, canes, or crutches? |
| 5. Gait | How is the patient’s ability to walk and maintain balance? |
| 6. Mental status | Is the patient oriented to their surroundings and able to understand and follow directions? |
Why is Secondary Diagnosis Important in Fall Risk?
The inclusion of secondary diagnosis in the Morse Fall Scale acknowledges that patients with multiple comorbidities are inherently at a higher risk of falls. A secondary diagnosis can represent a condition that independently impairs balance, strength, cognition, or overall physiological stability. For instance, a patient admitted for pneumonia (primary diagnosis) who also has a history of Parkinson’s disease (secondary diagnosis) faces a compounded risk of falling. Parkinson’s disease affects motor control and balance, increasing the likelihood of falls, especially when combined with the weakness and potential confusion associated with pneumonia and hospitalization.
Therefore, considering secondary diagnoses is not simply about counting medical conditions; it’s about recognizing the synergistic effect of multiple health problems on a patient’s fall risk. It prompts healthcare providers to look beyond the admitting diagnosis and consider the patient’s complete medical picture when assessing fall risk.
Calculating the Morse Fall Score and Interpreting Results
To calculate a patient’s fall risk using the Morse Fall Scale, healthcare providers must complete the assessment form, evaluating each of the six categories. Once the assessment is complete, the scores from each category are totaled to determine the patient’s overall fall risk score. The Morse Fall Scale score ranges from 0 to 125.
| Interpretation of Morse Fall Scale Results |
| :—————————————– | :—————– |
| Morse Fall Score | Risk Level |
| 0-24 | No or low risk |
| 25-45 | Moderate Risk |
| 45-125 | High Risk |
This scoring system provides nurses and other healthcare staff with a clear indication of a patient’s fall risk level, prompting them to implement appropriate prevention strategies as part of the individualized care plan. Facilities should establish clear guidelines for clinical staff regarding Morse Fall Scale interventions, outlining specific actions to be taken based on a patient’s identified risk level.
Implementing a Fall Risk Tool: A Step-by-Step Guide
Implementing a fall risk assessment tool like the Morse Fall Scale is a proactive step towards enhancing patient safety and reducing inpatient falls. It is crucial to remember that any risk assessment tool should be used in conjunction with clinical judgment, established policies, and procedures as part of a comprehensive risk reduction strategy. The specific choice of fall risk assessment tool may vary between healthcare facilities, and a combination of tools may be used to best address the needs of a diverse patient population. Here are key steps to effectively integrate a fall risk tool into your facility:
1. Establish Fall Prevention Committees
Depending on the size and structure of your healthcare organization, consider forming one or more shared governance committees dedicated to managing fall prevention strategies. These committees can include representatives from various units, serving as Fall Risk Champions, to address the unique needs of their patient populations. The committee’s primary goal is to collaboratively develop a Fall Prevention Bundle, encompassing strategies such as:
- Safety huddles to proactively discuss patient risks.
- Hourly rounding to address patient needs and environmental safety.
- Consistent use of the Morse Scale for risk assessment.
- Implementation of individualized interventions based on assessed risk.
- Post-fall debriefs to learn from incidents and improve prevention strategies.
2. Develop a Comprehensive Policy Guide
Healthcare leadership should create a detailed policy guide for staff, clearly outlining the rationale and procedures for each element within the fall risk bundle. This guide should include specific instructions on:
- Frequency of fall risk assessments.
- Recommended interventions based on different fall risk levels.
- Detailed Morse Scale documentation protocol to ensure consistent and accurate record-keeping.
3. Integrate a Flowsheet into Workflow
Once the organization selects a fall risk assessment tool, decide how it will be integrated into the nursing workflow and documented. Embedding a flowsheet into the nursing shift assessment is an effective approach. This flowsheet should include sections for documenting fall-prevention interventions implemented, such as:
- Raising side rails as appropriate.
- Activating bed alarms.
- Ensuring patients wear non-slip socks.
- Maintaining adequate lighting in the patient room.
- Placing the call bell within easy reach.
- Assigning a sitter at the bedside when necessary.
Remember that flowsheets may require customization for different departments to address specific patient populations. For instance, the Morse Scale may not be optimal for pediatric patients. In pediatric units, consider using the Little Schmidy Fall Scale which is specifically designed for children.
4. Provide Thorough Staff Education
Providing comprehensive education to nurses and relevant staff on the proper use of the fall risk assessment tool is paramount. Education programs should be tailored to the needs of each nursing unit and should cover all aspects of the policy guide, including Morse Fall Scale score interpretation and intervention guidelines. Emphasize the importance of modifying patient room design elements, such as bed height and furniture placement, to proactively minimize fall risks.
Enhancing Patient Safety Through Proactive Fall Prevention
Implementing a fall risk assessment tool like the Morse Fall Scale, with careful consideration of factors like secondary diagnosis, is a crucial step for healthcare organizations committed to improving patient outcomes and safety. By prioritizing fall prevention and utilizing effective assessment tools, facilities can create a safer environment for patients and reduce the incidence of preventable falls. For more strategies to enhance patient safety in your healthcare facility, explore resources available through professional healthcare networks and publications.
