Our Nursing Department supports the hospital's strategic quality movement by continuously promoting and cultivating a learning culture for quality improvement among the nurses. We believe that with every improvement we make to our quality of nursing care, we can play an important role in ensuring better safety and outcome for our patients who come under our care.

Our Quality Framework

The Nursing Quality Improvement (NQI) Framework that the Nursing Department has adopted since 2005 aims to achieve the following objectives:

Provide a coordinated Quality Improvement (QI) programme for nurses
Ensure nursing services delivered are monitored for quality and appropriateness of care
Establish monitoring and feedback mechanisms for evaluation and continuous improvement to service delivery
Promote evidence-based nursing practice
Promote a strong culture of QI among nurses

Under this framework, we have established committees to plan and oversee the implementation of the nursing quality movement. It emphasises a "bottom-up" approach in encouraging ownership and participation by nurses in quality improvement and patient safety initiatives. Nursing Standards Teams, comprising both junior and senior nurses, from the patient care areas are actively engaged in initiating and implementing quality improvement projects, performing RCA (Root Cause Analysis), and adopting problem-solving approach via the PDCA (Plan-Do-Check-Act) method to tackle nursing issues (such as falls and pressure ulcer prevention).

Our Activities

We organise monthly Quality Improvement (QI) Rounds to help spread the quality message and share useful quality-related information with all nurses. This forum provides an excellent platform for them to keep abreast of the latest developments in quality and patient safety initiatives, as well as to share innovative ideas to address common nursing issues.

We also encourage our nurses to attend in-house programmes such as the Clinical Practice Improvement Programme (CPIP), risk management courses and patient safety workshops. Clinical lectures are also organised in collaboration with other healthcare professionals to keep them updated on the latest evidence-based care. With the added knowledge and skills, we believe our staff will be better empowered to take on the responsibilities to improve our nursing care standards and quality.

To ensure that the quality initiatives are effectively implemented, the respective patient care units perform regular audits for compliance and to identify areas for improvement. Analysed results are shared to create awareness and action plans are formulated to address areas identified for improvement. Nurses are constantly encouraged to share and adopt best practices.

Clinical Outcomes

Under the Nursing Balance Scorecard, KPIs (Key Performance Indicators) such as inpatient fall rates and hospital-acquired pressure ulcer rates are measured and monitored to evaluate the effectiveness of the quality improvement and patient safety initiatives introduced. The clinical outcome of these indicators are trended and shared at the various nursing forums and meetings with our nurses on the ground.

Fall Rates

With the concerted and focused approach under the NQI framework, we have been able to reduce our inpatient fall rates in 2009. The table below shows the comparison of the rates (per 1000 patient days) with 2008 performance and with UK and US hospitals:

2008 2009* UK US
Inpatient Fall Rates 1.06 0.85 4.80⁺ 4.76

* Figure up to September
⁺Source: Institute for Clinical Systems Improvement (ICSI). Prevention of falls (acute care). Health care protocol. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Mar.

The inpatient fall rates for 2008 and 2009 are considerably lower than the overall fall rates reported by hospitals in the United Kingdom and United States.

Pressure Ulcer Rates

The hospital-acquired pressure ulcer rates (per 1000 patient days) have also reduced significantly with the implementation of a few initiatives to reduce the risks of patients developing pressure ulcers.

2008 2009*
Inpatient Pressure Ulcer Rates 0.52 0.28
* Figure up to September