Paper
Friday, July 13, 2007
Improving quality of nursing care: A multi dimensional model to improve performance and prevent pain and decubitus ulcers in a tertiary health care facility
Rachel Mezan, RN, MA1, Ruth Balaban, RN, MA2, Orly Toren, RN, PhD3, and Hana Kerzman, RN, PhD1. (1) Nursing Division, THE CHAIM SHEBA MEDICAL CENTER, Ramat gan, Israel, (2) Nursing Division, Sheba Medical Center, Ram Gan, Israel, (3) Nursing division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| Learning Objective #1: LEARN ABOUT AN INTERVENTION BASED ON NURSING EBP MODEL TO IMPROVE PAIN TREATMENT AND TO PREVENT DECUBITOS ULCERS. |
| Learning Objective #2: LEARN ABOUT A multi dimensional model BASED ON EBP TO IMPROVE QALITY OF CARE. |
Preventing decubitus ulcers
and treating pain are in the nursing
core activities.
Since tertiary health care centers are characterized with extensive use of technology and complex health situations
, these activities have a major importance to nursing quality performance based on Evidence Based Practice (EBP).
Objective:
To describe a complete full intervention based on nursing EBP elements in the biggest tertiary medical center in Israel aiming to improve the quality of nursing intervention in pain treatment and prevention of decubitus ulcers in general departments (internal and surgical).
Intervention: A multi
dimensional intervention
to improve pain and prevent decubitus ulcers was implemented in the beginning of 2006. The model includes written obligatory standard procedures
(for pain and decubitus treatment);
advanced course
s for registered nurses focusing on
new interventions and treatments
based on EBP principals, assimilation procedures identical for all departments and quality control activities both using clinical actions and by retrieving data from electronic nursing records. Nursing measures used were the Norton scale (at admission) to identify the risk for developing ulcers
and the VAS scale for pain measurement. During 2006 monthly supervision
was obtained by specialists and managers to evaluate the
assessment and intervention.
Results: The results were compared between first and third quarters of 2006. The use of Norton scale was increased from 76% to 90% with no differences between internal and surgical departments. The VAS score increased, in the internal departments from 93% and 98%, and in the surgical department from 88% to 99%, respectively. The mean score of VAS measurement decreased from 2.7 to 1.3, respectively, in internal department, and from 3.6 to 1.8, respectively, in surgical departments. Summary: This intervention based on complete approach to reach quality of care show a better performance in nursing interventions. The model assists managers and nurses to reach better nursing quality care and to measure performance using clinical and electronic data.