Nursing
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Item Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?(Sage, 2013-10) Sanderson, M.; Allen, P.; Peckham, S.; Hughes, D.; Brown, M.; Kelly, G.; Baldie, Deborah; Mays, N.; Linyard, A.; Duguid, A.Objectives To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). Results GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. Conclusions There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them.Item Using quality improvement science to reduce the risk of pressure ulcer occurrence - a case study in NHS Tayside(Sage, 2014-11) Mackie, Susan; Baldie, Deborah; McKenna, E.; O'Connor, P.Pressure ulcer prevention is core to nursing practice and as such is often overlooked as a safety risk. A multifaceted quality improvement initiative guided by both Felgen's Model and the Model for Improvement delivered implemented in a systematic way led to significant improvements in the prevalence and incidence of pressure ulcers. Prevalence of all ulcers was reduced from 21% to 7% and to 3.1% when grade 1 ulcers are removed from analysis. Incidence (i.e. ulcers acquired in hospital) was reduced from 6.6% to 2.4% and 1.4% when grade 1 ulcers are removed from the analysis. Furthermore, improvements have been sustained for more than 2 years. This paper presents a case study of framework for change developed across a healthcare region NHS Tayside in Scotland.Item Extending the assessment of patient centredness in NHS Tayside(NHS Tayside, 2011) Jones, M. C.; Baldie, Deborah; Williams, B.; Rattray, J.; MacGillivray, S.; Abubakari, R.; McKenna, Eileen; Mackie, Susan