An Explanatory Case Study That Includes Evidence-Based Practice in a Hospital Setting

Healthcare organizations implement evidence-based instruments and integrate the instrument within the electronic health record with the aim of reducing patient harm while improving patient outcomes and standardizing procedures (Abraham, 2011; Kelley, Brandon & Docherty, 2011;Miake-Lye, Hempel, Ganz, & Shekelle, 2013; Stausmire & Ulrich, 2015). The Morse Fall Risk Scale is one such instrument that healthcare organizations use to identify a patient is a risk to fall (Morse, 2009). Once a patient is identified as a fall risk, specific interventions can be used that will assist in keeping the patient from falling (Yates & Creech, 2012). When inconsistencies exist within the process of implementing these instruments patient harm may occur (Lakish, Tschannen, Lee, 2012).

Evidence-based patient assessment instruments, such as the Morse Fall Risk Scale, are reliable and valid assessments when used as designed (Beaumont & Russell, 2012). Understanding the process nurses use when implementing the Morse Fall Risk Scale is important for preventing falls. This single explanatory case study used the components of high reliability theory to examine how medical-surgical staff nurses implement an evidence-based fall risk assessment instrument. Data was collected from an evidence-based belief survey (Melnyk, Fineout-Overholt, & Mays, 2008), observations of medical surgical nurses in practice, interviews with a subset of observed nurses, interviews with organizational leaders, staff and leader education records, and a review of the organizational policy and patient electronic health records. The collected quantitative and qualitative data was first analyzed separately and then triangulated (Almutairi, A., Gardner, & McCarthy; Yin, 2014), matching empirical patterns to propositional statements (Sarker & Lee, 2003) to explain the nurse’s process for implementing the Morse Fall Risk Scale. The elements of the high reliability theory explained the majority of the data, however new concepts emerged, including management role, forces impeding high reliability, nurses managing roles, judgment, and other considerations.