Nursing Practice Quality Improvement on Pressure Ulcer Prevention by Knowledge Management Department of Nurse, Surin Hospital

Abstract

 Blackground: Pressure ulcer is one of the most common complication according to lack of effective nursing care in hospital. Incidence of pressure ulcer among 235 hospitals in United State was 10.8% and 15 - 25% of chronic patients developed pressure ulcer. In 2004, incidence of 2nd -3rd degree pressure ulcer among hospitalized patient of Surin hospital was 1.8 per 1,000 patient days. This complication consequently increase cost of care. Therefore concept to develop nursing practice for pressure ulcer prevention had been used.
Objective: To review quality of nursing practice for pressure ulcer prevention and create best practice of Surin hospital.
Study design: Action Research
Method: Conceptual framework of this study adopted organizational knowledge management concept from Knowledge Management Institute (KMI) to improve standard of nursing practice to best practice for pressure ulcer prevention. The study has 3 phases as follow
1. Review phase: we evaluated outcome of existent practices then verified root causes, resolutions and alternatives. Sample group was specified by criteria (Barden score < 16). 101 patients from general surgery, medicine, orthopedic surgery and intensive care unit (12 wards totally) were recruited in this study. 4 research tools are either developed by researcher or quality assurance committee (QA).
2. Action phase: the alternatives from the evaluation were incorporated into standard practice for pressure ulcer prevention by knowledge management, experience and evidence-based practice sharing among 30 members of community of practice (CoP).
3. Outcome evaluation phase: result of new practice standard after implementation to sample group was evaluated by the same method of review phase including research tools and sampling criteria (119 patients). All research tools were assessed the accuracy by 5 experts. Data analysis was presented in percentage, frequency, mean, range and standard deviation (SD) by Microsoft Access.
Result: Nursing practice for pressure ulcer prevention score was consider as moderate (86%). Outcome of developed nursing practice improved and achieved goals when compared to previous practices in each indicator. Incidence rate of pressure ulcer per 1,000 patient day decrease from 1.6 to 0.7. Incidence rate of pressure ulcer per 1,000 patient day in risk group decrease from 12.7 to 5.0. Incidence rate of r1, 2nd, 3rd and 4th degree pressure ulcer per 1,000 patient day in risk group decrease from 1.8 to 1.7, 10.0 to 3.3 and 0.9 to zero respectively
Conclusion: The developed standard nursing practice for pressure ulcer prevention is effective and achieved goal standard in every indicators. Department of nurse should maintain and control quality of developed nursing practice to assure the quality of nursing care in pressure ulcer prevention in Surin hospital and regarded as best practice.
Key words: Pressure ulcer, Knowledge management, Quality assurance, Best practice