Transforming care strategies and nursing-sensitive patient outcomes

This paper is a report of the effects of implementing 13 Transforming Care At the Bedside improvement strategies on medication errors, patient falls and pressure ulcers.

A number of international reports and research studies have led to a focus on safety and quality in health care. Transforming Care At the Bedside involves nursing managers and front-line staff together contributing to practice improvement.

An observational, time series study in two medical units in one Australian hospital was conducted. Statistical process control analysis was used to identify changes in the outcomes. Routinely collected, anonymous clinical incident reports were used to calculate the proportion of reported clinical incidents that were reported to result in patient harm in the 15 months prior to and 18 months after Transforming Care At the Bedside strategies were implemented, between February, 2005 and December, 2007.

The proportion of reported medication errors, falls and pressure ulcers that resulted in harm as reported in clinical incident reports were reduced from 46.3% to 17.1%, 97.0% to 51.0% and 91.3% to 46.6% respectively, representing an absolute reduction by about one half. Consistent, sustained improvement in the first two was demonstrated, but analysis showed wide variation in the third--pressure ulcers--which meant that the differences in this outcome may have occurred by chance.

A rapid change management cycle such as Transforming Care At the Bedside can be a useful process when implementing numerous clinical changes in short succession.