The use of the Morse Fall Scale in an acute care hospital

Abstract

Background: Patient falls in hospitals account for a high proportion of adverse events. Assessing patient risk is a vital part of a fall prevention program. When a fall risk assessment tool is used, it is imperative to use one which is suitable for the hospital. Objective: The purpose of this study was to test the predictive validity of the Morse Fall Scale (MFS) by assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) on medicine units in an acute care hospital. Methods: Patient MFS scores were obtained from the medicine units. A total of 500 patient scores were collected along with a number of falls which occurred within 7 days of the fall risk assessment. Data were collected from November 2014 to March 2015. The setting was a large teaching hospital located in Ontario, Canada. Results: Using a cut-off point of 25 on the MFS, the sensitivity was 98% and the specificity was 8%. The PPV was 10% and the NPV was 97%. An MFS cut-off point of 55 provided the most balanced measure of sensitivity (87%) and specificity (34%) for accurate identification of fall risk. Conclusions: Findings suggest a change in practice is warranted as the values showed a poor balance between the sensitivity and specificity range. Recommendations for changes in practice include: changing the screening tool cut-off point from 25 to 55, or removing the use of a screening tool and assessing the risk by using another method.