改善塞拉利昂弗里敦一家转诊医院外科患者的护理记录：评估试点多层面质量改进混合型项目可行性的方案

Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project.

作者信息

Brima Nataliya, Sevdalis Nick, Daoh K, Deen B, Kamara T B, Wurie Haja, Davies Justine, Leather Andrew J M

机构信息

King's Centre for Global Health & Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.

Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

出版信息

Pilot Feasibility Stud. 2021 Jan 27;7(1):33. doi: 10.1186/s40814-021-00768-5.

DOI:10.1186/s40814-021-00768-5

PMID:33504369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7839195/

Abstract

BACKGROUND

There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone.

METHODS

This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory 'Theory of Change' process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases-(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention's effectiveness For improving nursing in this pilot setting.

DISCUSSION

We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone.

TRIAL REGISTRATION

Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

摘要

背景

在低收入和中等收入国家，迫切需要提高医疗服务质量，以降低外科疾病导致的可避免死亡率和发病率。目前，对于如何有效实施基于证据的卫生系统强化干预措施以改善这些地区的医疗服务质量，人们尚缺乏了解。为填补这一空白，我们开发了一项多方面的质量改进干预措施，以改善低收入国家医院环境中的护理记录。这个试点项目的目的是在塞拉利昂弗里敦的一家国家转诊医院的外科部门测试该干预措施。

方法

该项目由当地利益相关者和英国研究人员共同开发和设计，此前进行了多方法需求评估（定性、定量），并以参与式“变革理论”过程为指导。它采用了混合方法、准实验评估设计，以实施和改进科学理论方法为基础。它包括三个不同阶段：（1）实施前（项目设立以及对医院相关政策和表格的审查），（2）干预实施（宣传活动、培训包、审核与反馈），以及（3）对以下方面的评估：（a）实施干预措施并获取实施和过程结果的可行性，（b）使用实施结果评估实施策略对干预措施的采用、整合和接受程度的影响，（c）在这个试点环境中该干预措施对改善护理的有效性。