Syftet var att förbättra omhändertagandet av palliativa patienter i det sena skedet av palliativ vård på ett akutsjukhus med fokus på smärtskattning/registrering, antal brytpunktssamtal, efterlevandesamtal och användandet av det Svenska palliativregistret. Förbättringsarbetet kopplades till en studie vars syfte var att undersöka medarbetarnas erfarenheter av att arbeta med stöd av en palliativ omvårdnadskonsult.   Nolans förbättringsmodell har använts och genom PDSA har förbättringsidéer testats. Själva kontexten har beskrivits genom 5P. Styrdiagram (p- diagram) har använts för att analysera variationen i data.  Kvalitativa semistrukturerade intervjuer med 10 medarbetare för att fånga deras erfarenheter har analyserats med innehållsanalys.   Efter genomfört förbättringsarbete framkom att andel smärtskattade patienter var 89 % och antalet journalanteckningar avseende smärta ökade med 21 %. Andelen brytpunktsamtal har ökat och fler närstående erbjuds efterlevandesamtal. Vid intervjuer framkom att både patient och de närstående var nöjda med den vård de fått på avdelningarna.   Fyra teman innehållande 12 kategorier framkom i intervjuerna. Medarbetarna var generellt mycket positiva till införandet av en palliativ omvårdnadskonsult som stöd.  Det framkom också behov av kontinuerlig utbildning och vikten av samarbete och kommunikation inom teamen.   Det visade sig att PDSA cykler och styrdiagram var värdefulla metoder för uppföljning av förbättringsarbete på akutsjukhus. / The aim was to improve late stage palliative care in an acute hospital setting concerning pain assessment and management, documented decision to shift to end-of-life care, follow-up talk and compliance to the Swedish palliative registry. The improvement work was further studied by exploring the staff’s experience of working with support from a palliative consultancy nurse.    Nolan's improvement model was used including 5 P, PDSA cycles and control charts such as P-charts to analyze the variation. Qualitative semi-structured interviews with 10 employees regarding their experiences, have been analyzed with content analysis.    The results show that more patients were assessed for pain, 89% and charted medical records entries increased by 21 %. The percentage of documented decision to shift to end-of-life care increased and more relatives are offered follow-up talk and patient and relatives were satisfied.   Four themes including 12 categories emerged in the interviews. The staff were generally very positive to the consultancy nurse as a support. Results showed a need for continuous education and the importance of collaboration and communication within the teams.   PDSA cycles and control charts proved to be valuable methods for improvement work in an acute hospital setting.

<p><strong> </strong></p><p>There is a lack of research in the field of quality improvement efforts based on profound knowledge in social services. The current situation is therefore a significant knowledge gap in terms of studies of this type of systematic quality work and how it is applied in practice. This study therefore intends to describe Pilbackens quality work and further examine if the profound knowledge is consistent with quality work in microsystems by an analysis of Pilbackens work. The present study has been performed by a qualitative method and the material is collected through semi-structured interviews. In order to analyze the study’s result have profound knowledge and the model microsystems been used. The results show that Pilbackens in quality improvement efforts have made numerous changes in its organization. They have via a clear purpose and objective of working with quality in microsystems achieved a number of perceived and documented results. The analysis of Pilbackens quality work shows a compliance with profound knowledge and the ability incorporate microsystems in practice.</p>

There is a lack of research in the field of quality improvement efforts based on profound knowledge in social services. The current situation is therefore a significant knowledge gap in terms of studies of this type of systematic quality work and how it is applied in practice. This study therefore intends to describe Pilbackens quality work and further examine if the profound knowledge is consistent with quality work in microsystems by an analysis of Pilbackens work. The present study has been performed by a qualitative method and the material is collected through semi-structured interviews. In order to analyze the study’s result have profound knowledge and the model microsystems been used. The results show that Pilbackens in quality improvement efforts have made numerous changes in its organization. They have via a clear purpose and objective of working with quality in microsystems achieved a number of perceived and documented results. The analysis of Pilbackens quality work shows a compliance with profound knowledge and the ability incorporate microsystems in practice.