Feedback sessions every two weeks and monthly prizes for the best documentor helped monitor the progress of the project and incentivise the nurses to get involved. At the end of the project there was an increase to 78% documentation and nurses were more confident and knowledgeable in fluid monitoring and vital sign documentation.
Richard Richard is a nurse from Malawi who decided to focus his QI project on the use of pain medication during wound dressing changes. He found that within his unit many patients were experiencing a lot of pain during dressing changes as they either had no medication or were administered the medication during the change, which was too late to have the desired effect. A baseline study found that only 20% of patients were receiving adequate pain medication. The aim of Richard’s project was to improve this to 90% over a five- month period. New guidelines were developed through consultation with doctors, nurses, the palliative care team, pharmacy staff, patient attendants and clinical officers. In addition, the nurses in charge of the unit were given ownership to ensure strong morphine is in stock on the wards at all times. At the end of the five-month period 66% of patients reported that they had received sufficient pain control, up from 20%.
Patricia K and Patricia N In Malawi, senior nurse Patricia K. focused her QI project on improving hand hygiene in health workers at her hospital. As she could not be there for the entire project, her colleague Patricia N. took over some of the running of the project. Upon assessment it became clear that there was a lack of infrastructure in terms of both sinks and hand rub contributing to a low level of hand hygiene. Also, there were no reminders about hand hygiene anywhere in the unit. The baseline data collection found that the availability of hand washing stations was at 37% and hand hygiene practice was completed 5% of the time. Patricia created a hand hygiene committee to monitor, influence and sustain the project. Additionally, hand rub and hand washing stations were sourced and then placed strategically around the unit. Staff communication took place through meetings and posters. Throughout the process, feedback was given about the progress on the change in practice, which helped to address behavioural barriers as well.
Taweni is a theatre nurse from Malawi. It had become apparent to Taweni that the instrument decontamination in her unit was not to the highest standard, which can be problematic and cause infection when there is reuse of instruments. Taweni aimed to improve scrub nurse decontamination of instruments from 50% to 100% over a five-month period. Taweni implemented several strategies for change including training for both new and old staff and visual posters demonstrating the process of decontamination.
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