Sledování prevalence dekubitů jako indikátorů kvality ošetřovatelské péče na národní úrovni

Bc. Nina MÜLLEROVÁ

Master's thesis

Monitoring prevalence of pressure ulcers as a quality indicators of nursing care on national level.

Abstract:

Dekubity jsou celosvětovým problémem a jejich výskytu je třeba předcházet preventivními opatřeními a kvalitní ošetřovatelskou péčí. Přes všechna opatření se však nedaří jejich výskytu zamezit. Publikace odborníků jsou zaměřené na hodnocení ran, metody ošetřování, preventivní opatření výskytu dekubitů. Rovněž sledování výskytu dekubitů metodou prevalence nebo incidence je věnována značná pozornost ve světě a v posledních dvaceti letech i v České republice. Mezinárodní organizace zaměřené na hodnocení kvality zdravotní péče nebo profesní organizace sester navrhují standardy péče a konkrétní měřitelná kritéria. Také v České republice je potřeba stanovit standardizované ukazatele kvality ošetřovatelské péče, provádět porovnávání výsledků a sdílení informací mezi odborníky vedoucí k průběžnému zlepšování kvality (benchmarking), podporovat dobrou praxi. Ve světě je sledování ukazatelů kvality zdravotní péče zcela běžné, v České republice se tento proces rozvíjí. Pro sledování výskytu dekubitů nebyla dosud na národní úrovni stanovena metodika. V roce 2003 bylo provedeno první porovnání mezi čtyřmi fakultními nemocnicemi ve výskytu dekubitů metodou prevalenčního šetření, v roce 2005 byla rozpracována metodika pro sběr dat při řešení grantového úkolu IGA MZ ČR NO 77723-3 a proběhlo porovnání mezi šesti fakultními nemocnicemi. V roce 2008 byl realizován projekt kvality a bezpečí Ministerstva zdravotnictví s cílem vytvořit jednotnou metodiku pro prevalenční šetření a porovnávání standardního ukazatele v oblasti dekubitů na národní úrovní bez ohledu na typ zdravotnického zařízení s cílem tento ukazatel zařadit do Národní sady ukazatelů zdravotní péče. Cílem práce bylo ověřit, zda nová metodika a vyvinutý software jsou použitelné v praxi, a jak usnadnit jejich implementaci do praxe. Práce se zaměřuje na názory účastníků projektu na vyvinutý software, jeho využití v praxi a úskalí, která je potřeba pro implementaci do praxe překonat.

Abstract:

Abstract The diploma thesis is focused on the application of a national methodics for prevalence monitoring and comparison of pressure sores (decubitus ulcers) incidence in health care facilities in the Czech Republic. Pressure sores are a global problem and their incidence should be prevented by preventive measures and high-quality nursing care. However, despite all the provisions, we are not successful in the prevention of their incidence. It is necessary to define standardized quality indicators of the nursing care, to compare the results, and to share the information with specialists, which would result in continuous quality improvement (benchmarking), and to support good practice. In the world the quality indicators monitoring of health care is quite common, in the Czech Republic the process has been only developing. In the area of Czech nursing care only the falls in health care facilities are monitored on the national level. The methodics for the monitoring of pressure sore incidence has not been established yet on the national level. In 2003 the first comparison of four teaching hospitals was carried out in the incidence of pressure sores by means of the method of prevalence investigation. In 2005 the data collection methodics was elaborated during the solution of the grant project IGA MZ Č NO 77723-3. Six teaching hospitals were compared for the prevalence of pressure sores, with division into four specialty groups: internal medicine, surgical, intensive and follow-up care. In 2008 a project of quality and safety of the Ministry of Health was implemented, with a view to elaborate uniform methodics for prevalence investigation and comparison of a standard indicator in the area of pressure sores at the national level, regardless of the type of a health care facility. At the meeting of the Work Group for Health Care Quality of the Ministry of Health of the Czech Republic I recommended to include the indicator in the National Set of Health Care Indicators. The work aims at the verification of the applicability of the new methodics and software in practice, and at the facilitation of their implementation into practice. It is focused on the opinions of the project participants on the developed software, on its application into practice and on the challenges that should be tackled during the implementation into practice. In order to get the necessary information, we have chosen a method of qualitative investigation using a semi-structured interview. Eight respondents, direct participants in the project, were interviewed. According to the results of the interviews, health facilities pay much attention to the pressure sores monitoring. The investigations are carried out by means of an incidence and prevalence method. The monitoring of pressure sores incidence has not been included in clinical information systems yet, and it is carried out in several different ways. The interest in comparison between hospitals (benchmarking) is considerable. The results of the investigation are used above all for the purpose of improvement of measures preventing the incidence of pressure sores, of the improvement of quality of nursing care, and of reducing the workload of nurses. The extent of the economic impact of the pressure sores incidence on health facilities is not clear. If we want to facilitate the application of national methodics of monitoring the pressures sores prevalence to practice and the use of application software, we should ensure adequate awareness of health care managers, training of teams of health professionals, coordinators and editors, who will go on to work with the national methodics. The monitoring of the national quality indicator in the area of pressure sores is another shift in the implementation of goals of the Ministry of Health concerning the quality of care and safety of the patients.

Keywords

Dekubitus, ukazatel kvality, péče, metodika, prevalence, software, benchmarking.

Language used: Czech

Date on which the thesis was submitted / produced: 17. 8. 2009

Accessible from:: 17. 8. 2009

Identifier: 13045

Thesis defence

• Supervisor: doc. PhDr. Sylva Bártlová, Ph.D.

University of South Bohemia in České Budějovice

Faculty of Health and Social Studies

Master programme / field:
Nursing / Nursing in Selected Clinical Disciplines