Purpose: We implemented the “move to Morse” initiative as a part of our organizational continuous pursuit of excellence campaign to reduce falls and falls with injury. The aim was to ensure fall risk assessment and prevention strategies were evidence-based and easily translated into nurses’ practice.
Description: Fiscal year 2019 began with an increase in falls with injury. Nurses frequently needed to override the fall risk assessment tool, changing the risk from low/medium to high. Nurses voiced confusion translating the patient’s level of risk into practice. Upon review, the fall oversight committee noted that patients who fell with injury were often initially classified as low/moderate fall risk. The team concluded that a valid and reliable tool with clear interventions was needed unit observations, nurse focus groups, and fall case reviews were initiated immediately.
A review of literature of fall risk tools was conducted and the Morse falls scale was identified as a possible alternative to the current scale. Patients who fell with injury across the entire system were classified with both instruments. The Morse tool was found to be more sensitive to fall risk, and a decision was made to change to the Morse. Falls prevention interventions were simplified from 3 to 2 levels of risk. Policies, nursing flowsheets, and patient education materials were revised. Training was provided through in- services, unit rounding, tips of the week, and badge buddies.
Evaluation/outcome: In fiscal year 2013 falls per 1000 patient days occurred at a rate of 2.0 more than the NDNQI mean. Fall rates have decreased each subsequent year. By the end of fiscal year 2019, falls per 1000 patient days improved to rate of 0.2 below the NDNQI mean. Our falls-with-injury rate has been below the NDNQI mean since fiscal year 2013. As a result of our efforts, we reached the NDNQI top decile in the 2nd quarter of fiscal year 2019. Our fall prevention campaign has gone through several iterations. After the roll out of the Move to Morse Campaign, we have utilized a data-driven approach to refine our practices around fall prevention.
Implications: A valid and reliable tool is needed to predict fall risk. Nurses’ judgment always supersedes any tool. Ultimately, to reach our goal of zero harm, nurses need the best tool and the best interventions.