title: Improving the quality of nurse-influenced patient care in the intensive care unit.
abstract: BACKGROUND
  Quality of care is a major focus in the intensive care unit (ICU).
  
  
  OBJECTIVE
  To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU.
  
  
  METHODS
  A framework for QI was developed and implemented as part of a practice change initiative.
  
  
  METHODS
  Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies.
  
  
  RESULTS
  Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily).
  
  
  CONCLUSIONS
  The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing.
  
  
  CONCLUSIONS
  The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued.
authors.affiliation: Wellington Regional Hospital, Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Wellington, New Zealand.|Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, New Zealand.
authors.forename: Lynsey J
authors.initials: LJ
authors.lastname: Sutton
authors.affiliation: Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Jarden
mesh_terms: D003422:Critical Care / Q000592:standards*; D064648:Critical Care Nursing / Q000592:standards*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D009520:New Zealand; D009723:Nurse-Patient Relations; D005791:Patient Care; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D013997:Time Factors; D016896:Treatment Outcome
keywords: Audit; Nursing care; Practice change; Quality of care