Hybrid journal (It can contain Open Access articles) ISSN (Print) 1353-4505 - ISSN (Online) 1464-3677 Published by Oxford University Press[370 journals]
Authors:Male L; Noble A, Atkinson J, et al. Pages: 314 - 326 Abstract: PurposeKnowledge about patient experience within emergency departments (EDs) allows services to develop and improve in line with patient needs. There is no standardized instrument to measure patient experience. The aim of this study is to identify patient reported experience measures (PREMs) for EDs, examine the rigour by which they were developed and their psychometric properties when judged against standard criteria.Data sourcesMedline, Scopus, CINAHL, PsycINFO, PubMed and Web of Science were searched from inception to May 2015.Study selectionStudies were identified using specific search terms and inclusion criteria. A total of eight articles, reporting on four PREMs, were included.Data extractionData on the development and performance of the four PREMs were extracted from the articles. The measures were critiqued according to quality criteria previously described by Pesudovs K, Burr JM, Harley C, et al. (The development, assessment, and selection of questionnaires. Optom Vis Sci 2007;84:663–74.).ResultsThere was significant variation in the quality of development and reporting of psychometric properties. For all four PREMs, initial development work included the ascertainment of patient experiences using qualitative interviews. However, instrument performance was poorly assessed. Validity and reliability were measured in some studies; however responsiveness, an important aspect on survey development, was not measured in any of the included studies.ConclusionPREMS currently available for use in the ED have uncertain validity, reliability and responsiveness. Further validation work is required to assess their acceptability to patients and their usefulness in clinical practice. PubDate: 2017-03-02 DOI: 10.1093/intqhc/mzx027 Issue No:Vol. 29, No. 3 (2017)
Authors:Threapleton DE; Chung RY, Wong SS, et al. Pages: 327 - 334 Abstract: PurposeInform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators.Data sourcesA scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017.Study selectionInitial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations. Other documents were later sourced to identify and contextualize implementation issues.Data extractionStudy findings and implementation barriers and facilitators were charted and thematically synthesized.Results of data synthesisThematic synthesis using 30 publications identified 8 important components for integrated care in elderly and frail populations: (i) care continuity/transitions; (ii) enabling policies/governance; (iii) shared values/goals; (iv) person-centred care; (v) multi-/inter-disciplinary services; (vi) effective communication; (vii) case management; (viii) needs assessments for care and discharge planning. Intervention outcomes and implementation issues (barriers or facilitators) tend to depend heavily on the context and programme objectives. Implementation issues in four main areas were observed: (i) Macro-level contextual factors; (ii) Miso-level system organization (funding, leadership, service structure and culture); (iii) Miso-level intervention organization (characteristics, resources and credibility) and (iv) Micro-level factors (shared values, engagement and communication).ConclusionImproving integration in care requires many components. However, local barriers and facilitators need to be considered. Changes are expected to occur slowly and are more likely to be successful where elements of integrated care are well incorporated into local settings. PubDate: 2017-04-20 DOI: 10.1093/intqhc/mzx041 Issue No:Vol. 29, No. 3 (2017)
Authors:Wang H; Bradley C, Chang T, et al. Pages: 335 - 342 Abstract: ObjectiveTo examine the reliability and validity of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan (ADDQoL-CnTW).MethodsLinguistic validation procedures for patient-reported outcome measures were used to translate the Taiwan version from the original 19-item UK-English ADDQoL. The psychometric properties of the ADDQoL-CnTW were evaluated in a convenience sample, recruited from outpatient facilities, of 260 patients diagnosed with diabetes mellitus.ResultsThe forced one-factor solution supported one general 19-item factor with all items loading above 0.43, accounting for 51.5% of the variance, although the results of confirmatory factory analysis did not strictly adhere to a one-factor structure. Using Kaiser's Criterion, exploratory factor analysis identified four sub-dimensions but the pattern of loading also confirmed the presence of a large general factor with 11 of 19 items loading ≥0.4 on the first component, accounting for 49.73% of the variance. Internal consistency for the entire scale was 0.94. Convergent and discriminant validity were suggested by a stronger correlation of average weighted impact (AWI) scores with the overview Diabetes-specific QoL item than with the Present QoL item. The Present QoL item correlated better with the World Health Organization Quality of Life-BREF(TW) dimension scores than the Diabetes-specific QoL scores or the AWI scores. Insulin-treated patients reported significantly more negative AWI scores and Diabetes-specific QoL scores than those treated with tablets and/or diet, demonstrating known-groups validity.ConclusionsThe ADDQoL-CnTW revealed excellent internal consistency reliability, and showed evidence of validity for use in Taiwanese people with diabetes. PubDate: 2017-03-28 DOI: 10.1093/intqhc/mzx028 Issue No:Vol. 29, No. 3 (2017)
Authors:Keefe MJ; Loda JB, Elhabashy AE, et al. Pages: 343 - 348 Abstract: Methodology issueThe traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information.Proposed solutionWe propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery.EvaluationA simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration.Advice to practitionersDeterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems. PubDate: 2017-04-21 DOI: 10.1093/intqhc/mzx036 Issue No:Vol. 29, No. 3 (2017)
Authors:Manser T; Imhof M, Lessing C, et al. Pages: 349 - 359 Abstract: ObjectiveThis study aimed to empirically compare incident reporting systems (IRS) in two European countries and to explore the relationship of IRS characteristics with context factors such as hospital characteristics and characteristics of clinical risk management (CRM).DesignWe performed exploratory, secondary analyses of data on characteristics of IRS from nationwide surveys of CRM practices.SettingThe survey was originally sent to 2136 hospitals in Germany and Switzerland.ParticipantsPersons responsible for CRM in 622 hospitals completed the survey (response rate 29%).Intervention(s)None.Main outcome measure(s)Differences between IRS in German and Swiss hospitals were assessed using Chi2, Fisher's Exact and Freeman–Halton-Tests, as appropriate. To explore interrelations between IRS characteristics and context factors (i.e. hospital and CRM characteristics) we computed Cramer's V.ResultsComparing participating hospitals across countries, Swiss hospitals had implemented IRS earlier, more frequently and more often provided introductory IRS training systematically. German hospitals had more frequently systematically implemented standardized procedures for event analyses. IRS characteristics were significantly associated with hospital characteristics such as hospital type as well as with CRM characteristics such as existence of strategic CRM objectives and of a dedicated position for central CRM coordination.ConclusionsThis study contributes to an improved understanding of differences in the way IRS are set up in two European countries and explores related context factors. This opens up new possibilities for empirically informed, strategic interventions to further improve dissemination of IRS and thus support hospitals in their efforts to move patient safety forward. PubDate: 2017-03-07 DOI: 10.1093/intqhc/mzx030 Issue No:Vol. 29, No. 3 (2017)
Authors:Yan J; Liu K, Zhang L, et al. Pages: 360 - 365 Abstract: ObjectiveTo identify the frequency of undesirable events reported by patients during hospitalization and explore the relationship between undesirable events and perception of safety and satisfaction with care in China.DesignCross-sectional survey.SettingChinese university hospital.ParticipantsAdult patients (N = 341) discharged from medical and surgical departments.InterventionsPatients were interviewed post-discharge using a survey instrument to ask whether they had experienced specific undesirable events during hospitalization. Patient perception of safety and satisfaction with care received were also probed during this interview.Main outcome measuresFrequency of interpersonal problems, medical complications and healthcare process problems, and perception of safety and satisfaction with care.ResultsIn total, 601 undesirable events were reported (rate of 1.76 per person), including 229 interpersonal problems, 132 medical complications and 240 healthcare process problems. The most frequent event was insufficient explanation of medication side effects (22.9%). Both the perception of safety and satisfaction with care were related to the experience of undesirable events negatively.ConclusionsMany respondents experienced undesirable events during hospitalization and these experiences impacted negative on patients’ feelings toward the hospital. Engaging patients as partners in reporting undesirable events is a valuable tool for identifying and monitoring problematic areas of care. In order to encourage the contribution patients could make to improving patient safety, it is necessary to develop patient incident reporting systems. PubDate: 2017-03-10 DOI: 10.1093/intqhc/mzx029 Issue No:Vol. 29, No. 3 (2017)
Authors:Mekory T; Bahat H, Bar-Oz B, et al. Pages: 366 - 370 Abstract: ObjectiveTo evaluate the rate of medication related errors in the pediatric ward and pediatric emergency department (PED), before and after implementing intervention strategies according to the Joint Commission International (JCI) accreditation program.DesignA retrospective cross-sectional study that included chart review.SettingA university affiliated pediatric ward and PED.ParticipantsChildren 0–18 years old admitted on February 2013 (before the JCI program) and February 2014 (during implementation of the JCI program).Intervention(s)A training program designed to meet the JCI official standards on medication prescribing.Main outcome measure(s)The number of prescribing and medication administration errors in the 2 years.ResultsWe collected 937 valid prescription orders and 924 administration orders (1861 medical orders) from February 2013, and 961 valid prescription orders and 958 administration orders (1919 medical orders) from February 2014. There was a significant reduction in prescribing errors from 6.5 to 4.2% between years 2013 and 2014 (P = 0.03). There was no significant difference in administration error rates between the two periods (104 (11.3%) in the first period and 114 (11.9%) in the second; P = 0.61).ConclusionsThe errors rate we found was within the range described in the literature. Quality assurance interventions can significantly reduce medication prescribing errors. PubDate: 2017-03-10 DOI: 10.1093/intqhc/mzx031 Issue No:Vol. 29, No. 3 (2017)
Authors:Zecevic AA; Li A, Ngo C, et al. Pages: 371 - 377 Abstract: ObjectiveThe purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units.DesignA cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework.SettingA geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls.ParticipantsHospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management.InterventionImplementation of the SFIM to investigate fall occurrences.Main Outcome Measure(s)Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation.ResultsBoth hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication.ConclusionsSuccessful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly. PubDate: 2017-03-17 DOI: 10.1093/intqhc/mzx034 Issue No:Vol. 29, No. 3 (2017)
Authors:Aoki T; Ikenoue T, Yamamoto Y, et al. Pages: 378 - 383 Abstract: ObjectiveTo investigate the association between attributes of primary care and polypharmacy.DesignCross-sectional study.SettingA primary care practice-based research network in Japan (28 primary care clinics).ParticipantsAdult outpatients filled out a standardized questionnaire.Main outcome measurePolypharmacy defined as the use of five or more concurrent prescription or over-the-counter medications.MethodsAttributes of primary care were assessed via patient experience using the Japanese version of Primary Care Assessment Tool (JPCAT). Poisson mixed effects model was used to adjust for clustering within clinics and covariates.ResultsData were analyzed for 544 primary care outpatients. After adjusting for patients’ sociodemographic and health characteristics, the JPCAT community orientation score was found to be inversely associated with polypharmacy at the clinic level [risk ratio per 1 standard deviation increase = 0.83; 95% confidence interval (CI), 0.73–0.96; P = 0.008]. Sensitivity analyses using a different definition of polypharmacy showed results similar to those of the primary analyses.ConclusionsWe found that a higher level of community-oriented primary care is associated with a lower prevalence of polypharmacy in outpatients at the clinic level. These findings may be useful in developing community-based interventions to minimize polypharmacy. PubDate: 2017-03-22 DOI: 10.1093/intqhc/mzx035 Issue No:Vol. 29, No. 3 (2017)
Authors:Sasaki H; Yonemoto N, Mori R, et al. Pages: 384 - 391 Abstract: ObjectiveTo assess organizational culture in neonatal intensive care units (NICUs) in Japan.DesignCross-sectional survey of organizational culture.SettingForty NICUs across Japan.ParticipantsPhysicians and nurses who worked in NICUs (n = 2006).Main Outcome MeasuresThe Competing Values Framework (CVF) was used to assess the organizational culture of the study population. The 20-item CVF was divided into four culture archetypes: Group, Developmental, Hierarchical and Rational. We calculated geometric means (gmean) and 95% bootstrap confidence intervals of the individual dimensions by unit and occupation. The median number of staff, beds, physicians’ work hours and work engagement were also calculated to examine the differences by culture archetypes.ResultsGroup (gmean = 34.6) and Hierarchical (gmean = 31.7) culture archetypes were higher than Developmental (gmean = 16.3) and Rational (gmean = 17.4) among physicians as a whole. Hierarchical (gmean = 36.3) was the highest followed by Group (gmean = 25.8), Developmental (gmean = 16.3) and Rational (gmean = 21.7) among nurses as a whole. Units with dominant Hierarchical culture had a slightly higher number of physicians (median = 7) than dominant Group culture (median = 6). Units with dominant Group culture had a higher number of beds (median = 12) than dominant Hierarchical culture (median = 9) among physicians. Nurses from units with a dominant Group culture (median = 2.8) had slightly higher work engagement compared with those in units with a dominant Hierarchical culture (median = 2.6).ConclusionsOur findings revealed that organizational culture in NICUs varies depending on occupation and group size. Group and Hierarchical cultures predominated in Japanese NICUs. Assessing organizational culture will provide insights into the perceptions of unit values to improve quality of care. PubDate: 2017-03-28 DOI: 10.1093/intqhc/mzx038 Issue No:Vol. 29, No. 3 (2017)
Authors:An J; Kim S, Park S, et al. Pages: 392 - 398 Abstract: ObjectiveStrategies to promote patient involvement in medical error prevention have been implemented, but little is known about the effects of education on changes in perceptions and attitudes about patients’ own safety.DesignWe administered a survey to military personnel admitted to the Armed Forces Capital Hospital. Responses were classified according to perception and attitude.SettingSingle military hospital in Korea.ParticipantsA total of 483 completed surveys were included in our study; 252 of the respondents received safety education at admission.MethodsWe provided educational program material to one-half of the patients at admission (intervention group). The other one-half of patients received no safety education (non-intervention group). We then performed two rounds of a self-administered survey, based on whether the patient received patient safety education. Cronbach's alpha was calculated to determine scale score reliability. Regression analysis was used to evaluate associations between education and change in scores.ResultsScores for perception and attitude were greater in the intervention group. The results of the regression analysis revealed that compared with the non-intervention respondents, the respondents who received education had higher perception (estimate: 7.809, P < 0.0001) and attitude scores (estimate: 5.539, P < 0.0001).ConclusionOur study results suggested that patient education was associated with higher scores in both perception and attitudes about safety. To improve patient engagement in this area, efficient methods that encourage patient empowerment should be developed. Specialized health care providers who provide patient level education are needed to achieve a satisfactory patient safety climate. PubDate: 2017-03-28 DOI: 10.1093/intqhc/mzx037 Issue No:Vol. 29, No. 3 (2017)
Authors:Kim S; Park E, Kim S, et al. Pages: 399 - 405 Abstract: ObjectiveAlthough competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea.DesignPopulation-based retrospective observational study.SettingWe used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014.ParticipantsParticipants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis.Main outcome measure(s)The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization.ResultsHigh-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88–0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98–0.99) as well as after hospitalization compared with moderate-competition areas.ConclusionOur study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location. PubDate: 2017-04-07 DOI: 10.1093/intqhc/mzx042 Issue No:Vol. 29, No. 3 (2017)
Authors:Ehlers L; Simonsen K, Jensen M, et al. Pages: 406 - 411 Abstract: ObjectiveTo evaluate the effectiveness of unannounced versus announced surveys in detecting non-compliance with accreditation standards in public hospitals.DesignA nationwide cluster-randomized controlled trial.Setting and participantsAll public hospitals in Denmark were invited. Twenty-three hospitals (77%) (3 university hospitals, 5 psychiatric hospitals and 15 general hospitals) agreed to participate.InterventionTwelve hospitals were randomized to receive unannounced surveys (intervention group) and eleven hospitals to receive announced surveys (control group). We hypothesized that the hospitals receiving the unannounced surveys would reveal a higher degree of non-compliance with accreditation standards than the hospitals receiving announced surveys. Nine surveyors trained and employed by the Danish Institute for Quality and Accreditation in Healthcare (IKAS) were randomized into teams and conducted all surveys.Main outcome measureThe outcome was the surveyors’ assessment of the hospitals’ level of compliance with 113 performance indicators—an abbreviated set of the Danish Healthcare Quality Programme (DDKM) version 2, covering organizational standards, patient pathway standards and patient safety standards. Compliance with performance indicators was analyzed using binomial regression analysis with bootstrapped robust standard errors.ResultsIn all, 16 202 measurements were acceptable for data analysis. The risk of observing non-compliance with performance indicators for the intervention group compared with the control group was statistically insignificant (risk difference (RD) = −0.6 percentage points [−2.51–1.31], P = 0.54). A converged analysis of the six patient safety critical standards, requiring 100% compliance to gain accreditation status revealed no statistically significant difference (RD = −0.78 percentage points [−4.01–2.44], P = 0.99).ConclusionsUnannounced hospital surveys were not more effective than announced surveys in detecting quality problems in Danish hospitals.Trial Registration numberClinicalTrials.gov NCT02348567, https://clinicaltrials.gov/ct2/show/NCT02348567'term=NCT02348567. PubDate: 2017-04-13 DOI: 10.1093/intqhc/mzx039 Issue No:Vol. 29, No. 3 (2017)
Authors:Hoffman RL; Saucier J, Dasani S, et al. Pages: 412 - 419 Abstract: Quality problemPatients recently discharged from the intensive care unit (ICU) are at high risk for clinical deterioration.Initial assessmentUnreliable and incomplete handoffs of complex patients contributed to preventable ICU readmissions. Respiratory decompensation was responsible for four times as many readmissions as other causes.Choice of solutionForm a multidisciplinary team to address care coordination surrounding the transfer of patients from the ICU to the surgical ward.ImplementationA quality improvement intervention incorporating verbal handoffs, time-sensitive patient evaluations and visual cues was piloted over a 1-year period in consecutive high-risk surgical patients discharged from the ICU. Process metrics and clinical outcomes were compared to historical controls.EvaluationThe intervention brought the primary team and respiratory therapists to the bedside for a baseline examination within 60 min of ward arrival. Stakeholders viewed the intervention as such a valuable adjunct to patient care that the intervention has become a standard of care. While not significant, in a comparatively older and sicker intervention population, the rate of readmissions due to respiratory decompensation was 12.5%, while 35.0% in the control group (P = 0.28).Lessons learnedThe implementation of this ICU transition protocol is feasible and internationally applicable, and results in improved care coordination and communication for a high-risk group of patients. PubDate: 2017-03-22 DOI: 10.1093/intqhc/mzx032 Issue No:Vol. 29, No. 3 (2017)
Authors:Mamede F; Gama Z, Saturno-Hernández P. Pages: 420 - 426 Abstract: Quality problem or issueTo assess the quality of radiological examinations (REs) and to evaluate the effectiveness of a participatory continuous improvement approach to ensure best practices in a Portuguese hospital imaging department.Initial assessmentAt baseline, we found 232 (10.2%) non-compliances, mostly related to the criteria image centering and framing in chest radiography (CXR), proper use of radiological protection equipment in other conventional RE (CR) and X-ray beam collimation (CXR/CR).Choice of solutionA baseline and three consecutive evaluations of the RE quality were conducted. Each assessment was followed by participatory focused interventions for improvement.ImplementationFor each evaluation, we selected a random sample (n = 60) of cases for four types of examination (total n = 240 for each assessment, and 960 for the whole project). Both the building of quality criteria and the design of interventions for improvement were participatory, involving the radiology technicians. Estimates of criteria compliance were calculated with 95% confidence intervals. The statistical significance of absolute and relative improvements was tested using one-tail z-tests.EvaluationAfter the intervention, non-compliances decreased to 48 (2.1%). Compliance estimates improved in 25 of 38 criteria assessed, with statistical significance for 5 criteria in CXR and 3 in CR and digestive examination.Lessons learnedThe internal participatory approach enabled the identification of existing quality problems and, by focusing on the more frequent quality defects, was effective in improving the quality of RE. PubDate: 2017-03-02 DOI: 10.1093/intqhc/mzx026 Issue No:Vol. 29, No. 3 (2017)
Authors:Gan F; Tang X, Zhu Y, et al. Pages: 427 - 432 Abstract: Quality problem or issueThe traditional variable life-adjusted display (VLAD) is a graphical display of the difference between expected and actual cumulative deaths. The VLAD assumes binary outcomes: death within 30 days of an operation or survival beyond 30 days. Full recovery and bedridden for life, for example, are considered the same outcome. This binary classification results in a great loss of information.Initial assessmentAlthough there are many grades of survival, the binary outcomes are commonly used to classify surgical outcomes. Consequently, quality monitoring procedures are developed based on binary outcomes. With a more refined set of outcomes, the sensitivities of these procedures can be expected to improve.Choice of solutionA likelihood ratio method is used to define a penalty-reward scoring system based on three or more surgical outcomes for the new VLAD. The likelihood ratio statistic W is based on testing the odds ratio of cumulative probabilities of recovery R. Two methods of implementing the new VLAD are proposed.ImplementationWe accumulate the statistic W−W¯R to estimate the performance of a surgeon where W¯R is the average of the W’s of a historical data set. The accumulated sum will be zero based on the historical data set. This ensures that if a new VLAD is plotted for a future surgeon of performance similar to this average performance, the plot will exhibit a horizontal trend.EvaluationFor illustration of the new VLAD, we consider 3-outcome surgical results: death within 30 days, partial and full recoveries. In our first illustration, we show the effect of partial recoveries on surgical results of a surgeon. In our second and third illustrations, the surgical results of two surgeons are compared using both the traditional VLAD based on binary-outcome data and the new VLAD based on 3-outcome data. A reversal in relative performance of surgeons is observed when the new VLAD is used. In our final illustration, we display the surgical results of four surgeons using the new VLAD based completely on 3-outcome data.Lessons learnedFull recovery and bedridden for life are two completely different outcomes. There is a great loss of information when different grades of ‘successful’ operations are naively classified as survival. When surgical outcomes are classified more accurately into more than two categories, the resulting new VLAD will reveal more accurately and fairly the surgical results. PubDate: 2017-03-17 DOI: 10.1093/intqhc/mzx033 Issue No:Vol. 29, No. 3 (2017)
Authors:Richardson A; Peart J, Wright SE, et al. Pages: 433 - 439 Abstract: Quality problemCritical care patients often have several risk factors for pressure ulceration and implementing prevention interventions have been shown to decrease risk.Initial assessmentWe identified a high incidence of pressure ulcers in the four adult critical care units in our organization. Therefore, avoiding pressure ulceration was an important quality priority.Choice of solutionWe undertook a quality improvement programme aimed at reducing the incidence of pressure ulceration using an evidence-based bundle approach.ImplementationA bundle of technical and non-technical interventions were implemented supported by clinical leadership on each unit. Important components were evidence appraisals; changes to mattresses; focussed risk assessment alongside mandating patients at very high risk to be repositioned two hourly; and staff training to increase awareness of how to prevent pressure ulcers.EvaluationPressure ulcer numbers, incidence and categories were collected continuously and monitored monthly by unit staff. Pressure ulcer rates reduced significantly from 8.08/100 patient admissions to 2.97/100 patient admissions, an overall relative rate reduction of 63% over 4 years. The greatest reduction was seen in the most severe category of pressure ulceration. The average estimated cost saving was £2.6 million (range £2.1–£3.1).Lessons learnedA quality improvement programme including technical and non-technical interventions, data feedback to staff and clinical leadership was associated with a sustained reduction in the incidence of pressure ulceration in the critically ill. Strategies used in this programme may be transferable to other critical care units to bring more widespread patient benefit. PubDate: 2017-04-07 DOI: 10.1093/intqhc/mzx040 Issue No:Vol. 29, No. 3 (2017)
Hybrid journal (It can contain Open Access articles)
[370 journals]
