Using quality improvement science to reduce the risk of pressure ulcer occurrence - a case study in NHS Tayside
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Date
2014-11
Authors
Mackie, Susan
Baldie, Deborah
McKenna, E.
O'Connor, P.
Citation
Mackie, S., Baldie, D., McKenna, E. and O’Connor, P. (2014) ‘Using quality improvement science to reduce the risk of pressure ulcer occurrence – a case study in NHS Tayside’, Clinical Risk, 20(6), pp. 134–143. Available at: https://doi.org/10.1177/1356262214562916.
Abstract
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.