Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/10765
The subject of this paper can be categorised as a quality project, the aim of which was to improve quality of nursing and increase patient safety in three major fields of nursing;
pressure ulcers, nutrition and hospital hygiene. The paper is based on collaboration between Akureyri Hospital and a research group at Kristianstad University College, Sweden. The data
analysed consist of the results from six quality evaluations, which were carried out on the basis of previous evaluations which called for improvements. Improvements were implemented through an action plan for a set period of time and then the evaluations were
repeated. A comparison was made with results from previous evaluations. The results will form the basis for further development.
The method used consists of frequency measurements (point prevalence studies) on a predetermined day, followed by an agreed intervention, and repeated prevalence measurement approximately one year later (P-I-P method).
The rise in prevalence of pressure ulcers between 2005 (n= 34) and 2007 (n=48) is attributable to the increase in proportion of grade 1 pressure ulcers. Total 98 (2005) patients and 110 (2007) patients were included. Pressure ulcers of grade 1 were 88% (n=30) in 2005 and 96% (n= 46) in 2007. Pressure ulcers of grade 3 or 4 were recorded neither in 2005 nor in 2007. Sacral pressure ulcers decreased from 18% (n=6) 2005 to 6% (n=3) in 2007. The routine use of Modified Norton Scale increased significantly (p < 0.000) from 2005 (0%) to 46% 2007 (n=51). There was a significant improvement in risk assessment and use of turning/moving schedules (p < 0.003).
The results of the malnutrition/eating difficulties study showed a significant increase (p < 0.001) in documenting BMI in the charts, from one patient in 2006 to 28 patients in 2007. In 2006, 85 patients took part and 92 patients in 2007. In total 63% (n= 60) of the patients in 2006 and 58% (n=53) in 2007 had various eating difficulties. Unintentional weight loss was present in 20% (n=19) in 2006 in respectively 13% (n= 12), in 2007 (p <0.041) of the patients in 2007. In total 27% (n= 24) versus 18% (n=16) of the patients showed risk of under nourishment and actions taken to meet the risk of under nourishment had increased from 34% in 2006 to 47% 2007 (ns). Serving of small portion sizes decreased from 35% to 16% in 2007 (p <0.003). Body mass index over ≥ 25 was found in 52% (n= 49) 2006 and 54% (n=50) 2007 of the patients. The largest improvement to increase nutritional actions was to shorten the night fast for all patients in 2007 compared to 2006.
Total number of staff observed in the studies of hospital hygiene and microbiology of wounds was 158 in 2006 and 142 in 2008 and ten wards participated in 2006 and 11 in 2008. The results from the studies showed that substantial improvements were achieved in using short-sleeved scrubs (not significant) and in methodology for the disinfection of hands and forearms before and after wound dressing. There was significant improvement between the years in not wearing rings, jewellery (p < 0.0010), wristwatches and bracelets (p < 0.0001), in hair-hygiene (p <0.0013) and in the occasional use of gloves (p <0.0001). No multi resistant
Gram-negative bacteria, Meticillin resistant Staphylococcus aureus (MRSA) or Vancomycin Resistant Enterococci (VRE) were identified in 2006 or in 2008. Wounds were colonised with
high numbers of micro organisms, a situation which did not change after cleansing.
It seems that the Prevalence-Intervention - Prevalence (PIP) method based on the PDSA-quality circle (Shewhard’s cycle) is a optimal model for changes in nursing and optimisation of quality of care and patient safety including the role of leadership in nursing. This model can be denominated the P-I-P-Le method, where “Le” stands for leadership.