MORSE FALL SCALE RESULT

Date and time: [Date, time]
Patient: [Name or ID, age]
Unit: [Medical, surgical, day surgery, rehab, or long-term care]
Reason for scoring: [Admission, routine reassessment, after a fall, transfer, change in condition, or before discharge]
Scored by: [Name, credentials]

ITEMS
History of falling: [Finding, and its score on the form]
Secondary diagnosis: [Finding, and its score on the form]
Ambulatory aid: [What the patient walks with, and its score on the form]
IV or heparin lock: [Access in place or not, and its score on the form]
Gait: [What you saw as the patient rose and walked, and its score on the form]
Mental status: [What the patient says they can do, what you saw, and its score on the form]

TOTAL AND RISK LEVEL
Total: [0 to 125]
Risk level: [Low, moderate, or high, and the cutoffs the unit uses]
Last score: [Date and total, or first score this stay]
Not counted by the scale: [Sedatives or opioids, anticoagulant, diuretic or urgency, dizziness on standing, nerve block, low vision, or none]

INTERVENTIONS IN PLACE
Bed: [Low and locked, floor mat, rails as policy sets]
Call bell and belongings: [In reach, and whether the patient can use the bell]
Footwear: [Nonslip socks or own shoes]
Toileting: [Schedule, bedside commode, or staff stay during toileting]
Alarm: [Bed or chair alarm on, or not needed]
Supervision: [Standard checks, hourly rounding, room near the station, sitter, or video monitoring]
Walking: [Aid within reach, help needed, physical therapy referral]
Fall risk sign: [Wristband, door sign, or flag in the record, as policy sets]

EDUCATION
Patient: [What was taught, and the teach-back result]
Family: [Who was taught, and what]

REASSESSMENT
Next score: [Next shift, date, or the change that will trigger it]
Reported to: [Charge nurse, provider, pharmacist, or physical therapist, and when]

Signed: [Name, credentials, date and time]