ABSTRACT
INTRODUCTION: Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS: Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS: A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION: Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
Subject(s)
Homes for the Aged , Nursing Homes , Pressure Ulcer/prevention & control , Regional Medical Programs , Aged , Aged, 80 and over , Costs and Cost Analysis , Female , Homes for the Aged/economics , Humans , Longitudinal Studies , Male , Nursing Audit/economics , Nursing Homes/economics , Pressure Ulcer/epidemiology , Pressure Ulcer/nursing , Prevalence , Prospective Studies , Regional Medical Programs/economics , Regional Medical Programs/statistics & numerical data , Regional Medical Programs/trends , Switzerland/epidemiologyABSTRACT
Mapear, descrever e validar o processo de auditoria e faturamento de contas e recursos de glosas em um hospital geral, de grande porte, privado, foi o objetivo deste estudo. Pesquisa exploratória, descritiva, do tipo estudo de caso. Foram realizados momentos de observação não participante nos Setores de Auditoria Interna e de Recurso de Glosas do hospital visando o mapeamento dos processos objeto de estudo. Os dados obtidos foram validados por especialistas da área de auditoria de contas hospitalares, internos e externos ao hospital. Os processos, descritos e ilustrados na forma de três Fluxogramas, favorecem aos profissionais racionalizar as atividades e o tempo despendido no faturamento hospitalar evitando/minimizando a ocorrência de falhas e gerando resultados financeiros mais eficazes. O mapeamento, a descrição e a validação dos processos de auditoria e faturamento e recurso de glosas propiciaram maior visibilidade e legitimidade às ações desenvolvidas pelos enfermeiros auditores.
Our study aimed to map, describe and, validate the audit, account billing and billing reports processes in a large, private general hospital. An exploratory, descriptive, case report study. We conducted non-participatory observation moments in Internal Audit Sectors and Billing Reports from the hospital, aiming to map the processes which were the study objects. The data obtained was validated by internal and external audit specialists in hospital bills. The described and illustrated processes in three flow-charts favor professionals to rationalize their activities and the time spent in hospital billing, avoiding or minimizing the occurrence of flaws and, generating more effective financial results. The mapping, the description and the audit validation process and billing and, the billing reports propitiated more visibility and legitimacy to actions developed by auditor nurses.
Subject(s)
Income/policies , Financial Management, Hospital/economics , Nursing Audit/economics , DocumentationSubject(s)
Burnout, Professional/etiology , Burnout, Professional/prevention & control , Clinical Alarms/adverse effects , Clinical Alarms/economics , Nursing Audit/methods , Photography/methods , Video Recording/methods , Burnout, Professional/economics , Clinical Alarms/statistics & numerical data , Cost-Benefit Analysis , Feasibility Studies , Humans , Nursing Audit/economics , Photography/economics , United States , Video Recording/economicsABSTRACT
A auditoria iniciou seu foco na área contábil com controle de custos. Porém, a auditoria sofreu uma mudança de paradigma e,atualmente, é uma ferramenta de apoio à gestão, buscando a excelência em aspectos técnicos, administrativos, éticos e legais. Asanotações de enfermagem, neste contexto, são alvo de auditorias nos serviços de saúde devido à representação de todo o cuidadoprestado ao paciente, além de sua importância para os custos hospitalares e as glosas. Este estudo teve a intenção de verificar,através da revisão da literatura nacional publicada no período de 2000 a 2010, a importância e os fatores intervenientes nasanotações de enfermagem para as glosas hospitalares. Foi possível identificar a importância dos registros de enfermagem e como asanotações de enfermagem contribuem para as glosas hospitalares. Sugere-se uma nova forma de gestão hospitalar junto aoenfermeiro auditor, equipes de educação continuada e a utilização da Sistematização da Assistência de Enfermagem para uma melhorqualificação do cuidado e excelência em enfermagem, além da diminuição do número de glosas nas instituições hospitalares.
The audit began focused on accounting with control of costs. However with a change of concept is now a tool to support management,striving for excellence in technical, administrative, ethical and legal aspects. Nursing notes are subject to audit in health services dueto the representation of all patient care. This study was intended to check through the literature review, the importance of thenursing glosses in hospitals and found that they contribute greatly in this and reinforces the importance of new hospital managementtechnics with the nurse auditor, continuing education and the use of Nursing Care Systematization for the qualification and excellencein nursing.
La auditoría empezó su enfoque en la contabilidad, el control de costes mas sufrió un cambio de paradigma en lo que hoy es unaherramienta para apoyar la gestión, búsqueda de la excelencia en los aspectos técnicos, administrativos, éticos y legales. Las notasde enfermería están sujetos a la auditoría de los servicios de salud debido a la representación de todos el cuidado del paciente. Esteestúdio fue deseñado para verificar a través de la revisión de la literatura, la importância de las glosas de enfermeira em el hospotaly encontró que contribuyen em gran medida em las glosas y refuerza la importancia de um nuevo modelo de gestión com el auditorenfermeira, educación continua y el uso del Sistema de Cuidado de Enfermería para la calificación y la excelência em enfermeira.
