Assessing the Impact of a Transforming Care Initiative in the Australian Context

Abstract

Hospitalised patients experience harm as a consequence of adverse events, including inpatient falls and hospital-acquired pressure ulcers. Nurses are attempting to address this situation with the development of international initiatives aimed at improving the safety and quality of nursing care. Evidence to support the implementation of these initiatives is limited, yet widespread implementation continues. The aim of this study was to understand the implementation, impact and sustainment of an initiative to transform nursing care in four acute medical-surgical units. The focus of the initiative was to provide a patient centred framework to improve the safety and quality of nursing care. A number of interventions were implemented such as clinical bedside handover and rounding. This study was conducted in two phases. Phase One used a non-equivalent control group design with historical controls and an uncontrolled interrupted time series. More than 10,000 patients discharged between July 2008 and December 2010 were included. Patients discharged during the initial three months of implementation, were excluded. Two nurse-sensitive indicators were used as outcome measures; inpatient falls and hospital-acquired pressure ulcers. Coded administrative data were analysed using statistical process control to identify changes in the nurse-sensitive indicators over time.