The effect of a transforming care initiative on patient outcomes in acute surgical units: a time series study.

AIM: To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers. BACKGROUND: Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives. DESIGN: This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time. RESULTS: The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation. CONCLUSION: These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.

Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues.

AIMS AND OBJECTIVES: To review nurse-sensitive indicators that may be suitable to assess nursing care quality. BACKGROUND: Patient safety concerns, fiscal pressures and patient expectation create a demand that healthcare providers demonstrate the quality of nursing care delivered. As a result, nurse managers are increasingly encouraged to provide evidence of nursing care quality. Nurse-sensitive indicators are being proposed as a means of meeting this need. DESIGN: Literature review. METHODS: A review of the literature was conducted using CINAHL and MEDLINE from 2002-2011. Key search terms were nurs* and sensitive indicators, outcome measures, indicators, metrics and patient outcomes. RESULTS: Most of the research has examined the relationship between nursing structural variables and patient outcomes in acute care settings and have explored potential indicators for specific patient groups and nursing roles. When using nurse-sensitive indicators, issues concerning the selection, reporting and sustained use are important for nurse managers to consider. CONCLUSION: Evidence for the nurse-sensitivity of some commonly used indicators is inconsistent due to the disparity in definitions used, data collection and analysis methods. Further research on the application and implementation of these indicators is required to assist nurse managers in attempting to quantify the quality of nursing care. Nurses need to continue to strive to achieve agreement on the definitions of indicators, gather strong consistent evidence of nurse-sensitivity, resolve issues of regular data collection and consider selection, reporting and sustainment when implementing nurse-sensitive indicators. RELEVANCE TO CLINICAL PRACTICE: Once identified, nurse-sensitive indicators can be applied for quality improvement purposes, but consensus is required to fully realise their potential. Nurse managers need to be aware of the factors that can influence the use of indicators at unit level. Strategies need to be implemented to promote these indicators becoming integrated with routine nursing care.

Effectiveness of a computer based medication calculation education and testing programme for nurses.

The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety.

A discussion of approaches to transforming care: contemporary strategies to improve patient safety.

AIM: This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group(®). BACKGROUND: International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. DATA SOURCES: Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. DISCUSSION: A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. IMPLICATIONS FOR NURSING: These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. CONCLUSION: All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes.