Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon


  • Nada Nassar BSN, MSN, RN,

    Nursing Quality Improvement Officer, Corresponding author
    1. Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
    • Correspondence: Nada Nassar, Nurse Quality Improvement Officer, AUBMC, Cairo Street, 110236 Beirut, Lebanon. Telephone: +9611350000 ext. 6198.


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  • Nancy Helou PhD(c), RN,

    1. The University of Health Sciences, Lausanne, Switzerland
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  • Chantal Madi BSN, MS, RN

    Associate Director for Nursing Services
    1. American University of Beirut Medical Center, Beirut, Lebanon
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Aims and objectives

To assess the predictive value of two instruments (the Morse Fall Scale (MFS) and the Heindrich II Fall Risk Model (HFRM)] in a Middle Eastern country (Lebanon) and to evaluate the factors that are related to falls.


A prospective observational cross-sectional design was used.


Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling.


Data from 1815 inpatients at the American University of Beirut Medical Center (AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM.


The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling.


Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity.

Relevance to clinical practice

It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient.