DR.

JAYAHARAN MEMORIAL HOSPITAL

33, VICTORIA PRESS ROAD, NAGERCOIL - 629 001.
04652 - 222664 & 233337 04652 – 223869
jmh_ngl@yahoo.in

Falls: Morse Fall Scale

Patient Name: Age: Sex: M/F

Consultant Name: PID No: Bed No:

Variables Score reassess.

 No (score as 0)..........................................................

History of falling  Yes (score as 25).......................................................

 No (score as 0)..........................................................

Secondary diagnosis  Yes (score as 15).......................................................

 Bed rest / nurse assist (score as 0)...........................

Ambulatory aid  Crutches/ cane/ walker (score as 15).......................

 Furniture (score as 25)............................................

 No (score as 0).........................................................

IV or IV access  Yes (score as 20).......................................................

 Normal/ bed rest/ immobile (score as 0).................

Gait  Weak (score as 10)....................................................

 Impaired (score as 20)..............................................

 Knows own limits (score as 0)...................................

Mental status  Overestimates or forgets limits (score as 15)...........

Total Score

Signature

Risk Level MFS Score Action

No risk 0-24 Good basic nursing care

Low to moderate 25-45 Implement standard fall prevention interventions using

the falling leaf program

High risk 46+ Implement high-risk fall prevention interventions using

the falling leaf program.