The SAFE or SORRY? programme. part II: effect on preventive care

Abstract

BACKGROUND: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. OBJECTIVE: The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given. DESIGN: Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008. SETTINGS: Ten hospital wards and ten nursing home wards. PARTICIPANTS: We monitored nursing care given to adult patients with an expected length of stay of at least five days. METHODS: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed. RESULTS: The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate=6%, CI: -7-19) and nursing homes (estimate=4%, CI: -5-13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate=19%, CI: 17-21). For falls in hospitals and nursing homes, no more patients at risk received preventive care. CONCLUSION: Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators.