🚶 Morse Fall Risk Scale
The Morse Fall Scale (MFS) rapidly stratifies an inpatient's fall risk from six items, guiding the intensity of fall-prevention measures.
Morse Fall Risk Scale
Fall history in the past 3 months
≥ 1 medical diagnosis (multiple diagnoses)
Ambulatory aid
IV therapy/heparin lock
Gait
Mental status
When to use
Score history of falling, secondary diagnosis, ambulatory aid, IV/heparin lock, gait, and mental status; sum them. A higher total means higher fall risk and triggers escalating preventive measures.
How it works
Total = fall history (0/25) + secondary diagnosis (0/15) + ambulatory aid (0/15/30) + IV or heparin lock (0/20) + gait (0/10/20) + mental status (0/15). Bands: 0–24 low · 25–44 moderate · ≥45 high.
Key points
- Thresholds are institution-tunable; many hospitals set the high-risk cut at 45, while some use 51 — calibrate to local population and intervention capacity. (original synthesis · not guideline verbatim)
- The 'ambulatory aid' item scores 30 when the patient uses furniture for support, higher than using a cane/walker (15) — clutching furniture signals greater instability.
- The score is a triage tool, not a substitute for individualized assessment; combine with environmental rounds, medication review (sedatives/antihypertensives), and toileting schedules.
References
- Morse JM, et al. Development of a scale to identify the fall-prone patient. Can J Aging. 1989;8(4):366-377.
- Agency for Healthcare Research and Quality (AHRQ). Preventing Falls in Hospitals Toolkit.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.