Score fall-risk factors on the Morse Fall Scale — history of falling, secondary diagnosis, ambulatory aids, IV, gait, and mental status. Total points guide fall precautions.
Fundamental concept
Scoring fall history, secondary diagnoses, ambulation aids, IV therapy, gait, and mental status to target fall precautions.
An older adult with delirium from pneumonia has no documented falls in 3 months but has pneumonia as a secondary diagnosis, is bed rest only, a saline lock in the left forearm, immobile gait score, and repeatedly tries to climb out of bed.
Rate Morse fall-risk factors for delirium and immobility.
History of Falling
Secondary Diagnosis
Ambulatory Aid
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