Comparison of Morse Fall Scale to Medicare Fall Risk Assessment Tool

Comparison of Morse Fall Scale to Medicare Fall Risk Assessment Tool
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Comparison of Morse Fall Scale to Medicare Fall Risk Assessment Tool
Falls and fall-related injuries continue to be major problems among the elderly, particularly those living in Long Term Care Facilities (LTCF). According to Gringauz et al. (2017), falling is a common occurrence among patients during their hospital stay and it has both financial and clinical outcomes for the healthcare organization. Falls, therefore, mean a strain on the institution's resources, including financial and human resources. According to Bagui et al. (2019), the rate of inpatient falls stands at 3-5 per 1000 inpatient days while about a third of all patient falls leads to injury, including death. Falls are associated with not only an increase in hospital stay but also the cost of care for the patient (Bagui et al., 2019). Furthermore, about 30% of individuals aged over 65 and half of those aged above 80 experience a fall at least once per year (Bóriková et al., 2018). In LTCF, the falls rate is thrice as much as in the community of seniors, with of older adults in the facilities experiencing at least a fall every year (Bóriková et al., 2018). Apart from the strain on resources, some of the consequences associated with falls include functional decline, loss of independence, injury, pain, distress, and fear of falling. Falls, therefore, pose a significant health challenge that health practitioners must address. Falls assessments tools play a vital role in the identification of the specific risk factors associated with falls and their predictive validity determines to a great extent the rate of falls in a particular healthcare facility. In this regard, this project seeks to compare Morse Fall Scale (MFS) to Medicare Fall Risk Assessment tool among elderly people in a LTCF and consequently develop recommendations to reduce falls and falls-related injuries.
Fall prevention and a better evaluation of the risks factors for falls will go a long way in improving the quality of care offered by LTCF. Understanding the risks factors associated with falls in the LFTC is key to developing relevant and effective preventive strategies. An improvement in the prevention of falls means not only reduced healthcare costs but also a reduction in the impact of the consequences associated with falls. A comparison of MFS to the Medicare Fall Risk Assessment tool will yield an understanding of which tool is better in predicting high-risk residents as well the key risk factors associated with falls among the elderly in the facility. A clear understanding of the fall risk factors in the facility based on the more efficient tool will be integral in developing improvement interventions tailored towards reducing falls incidents. It is important to recognize that an assessment tool can guide the allocation of resources towards the prevention of falls in a facility. Therefore, an improved prediction of the incidences of falls in a facility allows for the optimal allocation of resources.
The purpose of the project is to determine the better tool between MFS and Medicare Medicare Fall Risk Assessment in predicting the residents with the highest risk of falling and in the process develop intervention strategies based on the key risks identified. The model that will guide the project process and implementation is John Hopkins Evidence-Based Practice Model, which focuses on translating the best evidence into practice (Schaffer et al., 2013). As described by Schaffer et al. (2013), the model is comprehensive as it covers all key components of the EBP process. The project seeks to achieve several aims. First, the project aims to compare MFS and Medicare Fall Risk Assessment in a nursing home. Second, the project seeks to determine the main fall risk factors in the facility. Third, the project aims to develop improvement intervention strategies based on the risks identified. The primary outcomes of the project include the number of high fall risk residents identified by the Morse Fall Scale, the number of high fall risk residents identified by Medicare Fall Assessment, the number of falls before implementation, and the number of falls after implementation. A secondary outcome of interest is the key risk factors associated with falls in the facility. The study question of the project is: in the elderly living in long-term care facilities, what is the impact of the MORSE Fall scale compared with the Medicare Fall Risk Assessment in identifying those at high risk for falls?
Literature Review
The main search engines used include PubMed, CINHAL, Google Scholar, and ResearchGate. The key words that guided the search were falls risk assessment tools, long-term care facilities, falls prevention, Morse Fall scale, falls assessment AND Morse Falls Scale, and fall assessment, falls, aged, OR elderly. Based on these keywords, a total of 2539 publications were initially generated. Inclusion criteria included studies published between 2011 and 2021, articles published in the English language, and a population group of elderly aged above 65 years. Exclusion criteria applied were studies not published in English and non-peer-reviewed articles. After refining the search with inclusion and exclusion criteria, 110 articles were generated, and 10 were selected to be used in the project.
Many studies describe falls among the elderly as a major public health problem (Gringauz et al., 2017; Bóriková et al., 2018; Nassar et al.,2014). Falls among the elderly living in LTCF have been shown to occur more frequently compared to those dwelling in communities (Glass & Mendelson, 2020;). Not only do these falls contribute to increased costs of healthcare, but they are also associated with traumatic brain injury, increased anxiety and fear of falling, orthopaedic injuries, and even medical malpractice lawsuits (Glass & Mendelson, 2020; (Cho, et al., 2020). For LTCF, the rates of falls are three times more compared to the seniors' community, with about half of older adults in the facilities falling annually (Bóriková et al., 2018). It is evident that falls is a major public health problem and they are more pronounced in LTCF. In their research, Bóriková et al. (2018) note that if a set of risk factors associated with falls are known, many falls can be prevented. Given the significance of the problem, solutions tailored towards their reduction are necessary.
Numerous screening tools are in use in different healthcare settings to determine the risks of falls of patients. One of the most commonly used tools in predicting incidents of falls based on specific risk factors is Morse Falls Scale [MFS] (Bagui et al., 2019). According to Glass and Mendelson (2020), MFS allows for a simple and quick evaluation of the likelihood that a person will fall. The tool takes into account six items or variables: history of falling, secondary diagnosis, ambulatory aid, intravenous therapy, gait, and mental status (Sardo et al., 2016; Bagui et al., 2019). In regards to the history of falling, it is coded in the case where a patient had a fall in the last three months. A score of 25 is given for a yes and 0 is given for a no. Coding for secondary diagnosis is done if more than one diagnosis is indicated in the patient’s chart (Watson et al, 2016). A yes is given a score of 15 while a no is given a score of 0. As for ambulatory aid, a score of 30 is given for use of furniture, 15 for walker/cane/wheelchair/crutches/ and 0 for no ambulatory aid. A score of 20 is given if a patient has an IV/saline lock and 0 if not. In regards to gait, a score of 30 is given for a yes and 0 for a no. Finally, when it comes to mental health, a score of 15 is assigned for “forgets/overestimates” and 0 for “oriented” The responses to the items in the tool are assigned values and summed up to determine the risk of the individual falling. The total score for the tool range from 0 to 125, with >45 being the cut off-value that shows the individual has a high risk of falling (Bagui et al., 2019).
MFS assigns residents risks levels based on their score in the screening tool. Residents of a facility are ranked as having a low risk of falling when they score below 25, moderate risk when they score 25 and high risk when they score above ...