Μ. Διομήδους, Αναπλ. Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Α. Καλοκαιρινού, Καθηγήτρια, Νοσηλευτική, ΕΚΠΑ
Μ. Νταλαμάγκα, Αναπλ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Introduction: Quality improvement is an essential objective for contemporary healthcare organizations in their effort to achieve effectiveness and efficiency. For this purpose, quality standards (QS) have been widely adopted, while Integrated Hospital Information Systems (HIS) support quality management as well. However, meaningful and sustainable quality improvement remains challenging, as staff compliance lags behind. In the multivalent Intensive Care Unit (ICU) of the University General Hospital “Attikon” QS protocols have been implemented for the nursing staff, while the HIS is routinely used by the staff in daily administration of services.
Aim: To investigate the effect of a novel application, integrating QS protocols to the HIS, on staff compliance. Secondary aims were to explore the main causes of noncompliance and possible correlations and prognostic factors for staff compliance.
Methods: An add-on application, integrating ICU nursing protocols to the HIS was developed. An electronic check-list was also incorporated. The application was presented to the staff, explaining the aim of this intervention and that usage was optional. A cross-sectional study using semi-structured questionnaires was conducted in two stages: before and one month after implementation of the application. The target population consisted of the ICU nursing staff. Demographic data and length of total nursing and ICU working experience were recorded. The questionnaires recorded the self-reported compliance as well as the staff’s opinion about QS protocols and the application. Anonymity of the study participants and confidentiality of all data were ensured. Statistical analysis was performed using IBM-SPSS version 24 for Windows.
Results: The two questionnaires were completed by the entire nursing staff consisted of 30 nurses (9 male / 21 female), aged 35 years old (32-44 years) (median, range). The length of total nursing experience was 9 years (5-17 years) and the ICU working experience was 6 years (2-13 years). Twenty eight nurses (93%) responded they had knowledge of the QS protocols adopted by the ICU and 27 (90%) expressed positively about them. Before implementing the application to the HIS, the self-reported compliance rate was 53%, while 7% reported not complying and 40% complying partially. The main reasons for noncompliance, reported by 19 nurses, were heavy workload (58%) and personnel and material shortage (26%). There was a significant positive correlation between ICU working experience and compliance (r=0.406, p<0.05). ICU working experience was the only independent predictor of staff compliance (p=0.02, OR=2.86; CI: 1.16-7.06). After implementing the application, 26 nurses (87%) responded they were informed of the new application, while 22 of them (85%) expressed positively about it. The self-reported compliance rate after the intervention was 70%, showing a significant relative increase by 32% (p<0.001). Finally, 80% of the staff considered this application educational and 73% considered the electronic check-list useful in every day work.
Conclusion: ICU staff compliance with QS is compromised mainly due to a busy schedule and staff and material shortage. ICU working experience is positively associated and independently predicts a better compliance. The implementation of a simple application, integrating the QS protocols to the HIS, significantly enhanced staff compliance and it was well accepted by the staff.
Information system, Protocols, Quality, Standards