Formative qualitative evaluation of an improvement programme delivered in an English hospital trust to reduce harm from pressure ulcers

Abstract

Pressure ulcers (PUs) are a leading cause of preventable harm globally and can cause patients significant pain, infection and, in rare incidents, death. There is a strong evidence base for how to improve PUs and one UK healthcare trust used this evidence to develop a quality improvement (QI) programme using the Institute of Healthcare Improvement’s Breakthrough Series collaborative model. 20 teams, from both acute and community settings, participated in the first two phases of the collaborative. The delivery of both phases used virtual delivery using the Institute of Healthcare Improvement’s improvement model. This study sought to formatively evaluate the early phases of the collaborative, to support learning and continual improvements to the collaborative programme and other collaboratives delivered by the organisation based on the formative evaluation.

Methods Semi-structured interviews were conducted with purposively sampled participants to explore their perspectives about the implementation of the programme, interventions tested as part of the ‘change package’ provided and the pandemic’s impact.

Results A total of seven participants were interviewed, including acute ward managers, a charge nurse (deputy ward manager), a wound healing community nurse and a team leader community nurse. Interview durations varied from 9 min to 28 min. The interviews were kept short and stopped when data saturation was achieved as it was an extremely pressurised time for the organisation where the highest escalation alert was triggered on numerous occasions.

Conclusion A sustained reduction in PUs was achieved during the evaluation period and participants felt that the approach helped to achieve this, regardless of the adaptations made to the delivery method due to the pandemic. To support improvements, it is vital to ensure systems such as data collection are accurate and timely. The necessity for building strong foundations for QI capability must not be underestimated, as greater QI knowledge leads to better engagement and outcomes.