Improving the Completeness of Admission Nursing Instructions in the Dedicated Ward for COVID-19

 Background:

This ward belongs to a designated isolation and response hospital dedicated to caring for COVID-19 patients. In response to the outbreak of COVID-19, all 24 rooms and 32 beds in the ward have been converted for specialized care. The complete admission nursing instructions in the dedicated ward can increase patients' familiarity with the hospital environment and their compliance with infection control measures. Incomplete nursing instructions, on the other hand, may increase the risk of clustered infections and cause heightened anxiety among patients, indirectly affecting their satisfaction with the nursing instructions and increasing the workload of nursing staff.

Methods:

From March 1st to May 5th in 2021, a survey conducted via a project improvement approach revealed that the main reasons for the low completion rate of admission nursing instructions are as follows: (1) frequent changes in epidemic prevention policies, (2) the lack of an audit system in ward, (3) the diverse and unorganized health education materials without appropriate education tools, and (4) the lack of relevant education and training program for nursing staff. Through discussion, analysis, and literature review by team members of the project “Improving the Completeness of Admission Nursing Instructions in the dedicated ward for COVID-19”, the target completion rate of admission nursing instructions and the correct comprehension rate of admission nursing instructions by patients admitted to dedicated ward were set at 100% and 84%, respectively, by referencing the study “Enhancing the Satisfaction of Admission Nursing Instructions for Patients in the Iodine-131 Isolation Ward.” Solutions were proposed based on the decision matrix, and each solution was evaluated in terms of its feasibility, economic viability, and effectiveness, using a scoring scale of 5, 3, and 1 point. According to the 80/20 rule, implementation strategies were formulated for solutions scoring above 60 points. These strategies included the development of standard operating procedures for admission nursing instructions, the establishment of an audit system, the conduction of relevant in-service education for nursing staff, the integration of health education contents, and the creation of diverse health education tools for admission nursing instructions in the negative pressure isolation ward.

Results:

From October 1st to December 31st in 2021, the completion rate of admission nursing instructions for dedicated ward nursing staff increased from 67.4% to 100%, and the correct comprehension rate of admission nursing instructions by patients in the dedicated ward increased from 56.7% to 96.3%. The improvement rate for nurses was 48.4%, and the comprehension improvement rate for hospitalized patients after receiving nursing instructions was 70%.

Discussions:

This project has been established for nearly nine months. It was only able to be implemented with the consensus of the project team members, the support from the head nurse in the dedicated ward, and the assistance from the infection control nurses and the director of the infectious disease department in this hospital. However, during the initial phase of the project, the main challenge encountered was the diverse nursing instruction habits among the nursing staff. Ensuring their adherence to the standardized admission nursing instruction process became a top priority. In response to the increasing trend of foreign migrant workers and new immigrants as caregivers, the health education videos (QR code) and brochures in the dedicated ward were revised and produced in multiple languages, in order to reduce the anxiety, nervousness, and difficulties in focusing caused by language barriers and unfamiliar environments upon their admission. The measure facilitates nurses in conducting disease introduction and providing home care instructions, enabling patients and caregivers to familiarize themselves early with the hospital environment and comply with the ward management regulations. In addition, the in-service education for nursing staff was conducted to promote correct nursing instruction standards and the audit system in the dedicated ward was established. With the above efforts, this project was successfully implemented, achieving the goal of enhancing the completion rate of admission nursing instructions. In 2021, the patient satisfaction rate in the dedicated ward reached 96.9%.