Score and Assessment Systems

   
 
 

Morse Fall Scale

Author: Null
Address: http://www.primaris.org
Original Work: Null
Coypright: unknown
Trademark: unknown
Explanation: The Morse Fall Scale (MFS) is a rapid and simple method of assessing a resident’s likelihood of falling. The MFS is used widely in acute care settings. Fall Risk is based upon Fall Risk Factors and it is more than a Total Score. Determine Fall Risk Factors and Target Interventions to Reduce Risks. Complete on admission, at change of condition, transfer to new unit, and after a fall.
HL7 v2.x datatype: NM
HL7 V3 datatype: CO
Links: Morse Fall Scale
www.primaris.org
Specialities: Patient Care / Pflege

Interpretation

Codesystem Code Value(s) Interpretation
pseudo 1 0-24 no risk: good basic nursing care
pseudo 2 25-45 low to moderate risk: implement standard fall prevention interventions using the Falling Leaf Program
pseudo 3 46- high risk: implement high-risk fall prevention interventions using the Falling Leaf Program

Components

Comp. Decription Bezeichnung Code System: Codes/
Score Value		 Details /
Score Range		 /
Units		 HL7 DT v2 + V3 /
Snomed CT
1 History of falling
Note: If a resident falls for the first time, then his/her score immediately increases by 25.
no 0 - NM + CO
yes 25 - NM + CO
2 Seconday Diagnosis
no 0 - NM + CO
yes 15 - NM + CO
3 Ambulatory Aid
bed rest/nurse assist 0 - NM + CO
crutches/cane/walker 15 - NM + CO
furniture 30 - NM + CO
4 IV or IV access
 IV Access
no 0 - NM + CO
yes 20 - NM + CO
5 Gait
 Gang(art), Haltung
normal/bed rest/immobile 0 - NM + CO
weak 10 - NM + CO
impaired 20 - NM + CO
6 Mental Status
Mental Status When using this scale, mental status is measured by checking the residents self-assessment of his/her own ability to ambulate. Ask the resident, “Are you able to go to the bathroom alone, or do you need assistance?		 mentaler Status
knows own limits 0 - NM + CO
overestimates or forgets limits 15 - NM + CO
TOTAL SCORE Morse Fall Scale
The Morse Fall Scale (MFS) is a rapid and simple method of assessing a resident’s likelihood of falling. The MFS is used widely in acute care settings. Fall Risk is based upon Fall Risk Factors and it is more than a Total Score. Determine Fall Risk Factors and Target Interventions to Reduce Risks. Complete on admission, at change of condition, transfer to new unit, and after a fall.

Please send corrections and additions to hl7(at)oemig.de

Links to Further Information

General Note

The primary purpose of the information provided above is to enhance interoperability. The primary focus lies on the assigned codes.
Therefore, no guarantee can be given whether the use of the score or assessment system is allowed or not. It is highly recommended to check with the author directly. We are aware that the presented information may be not enough in order to work with it. The authors have done their best to ensure copyright and other jurisdictional requirements.

Date of Last Change: Nov 06, 2008 (FO)