This is an EcoQUIP first time project. Prior to their engagement in EcoQUIP the project partner and associate hospital (Zala County) had no previous experience of innovation procurement. The focus of the project has been capacity building, identification of an associate hospital and uncovering unmet needs.
The national project coordinator in Hungary, having no previous experience of innovation procurement, has undertaken an intensive programme of capacity building and exchange of experience with other project partners.
This involved receiving one‐on‐one tuition and coaching on innovation procurement theory and practice, attending Peer Learning events, Bi‐lateral exchange visits, Leadership training and Community of Learning exchanges. This enabled him to explain the project and concepts to hospitals and identify a suitable associate hospital with which to work and begin to transfer know how and work with them to identify an unmet need. Given the current economic climate in Hungary it has also been important to identify a subject that is realistic within current budgets and likely to be transferable to other hospitals.
During EcoQUIP actions designed to foster collaboration the project coordinator identified the patient environment as an area where there are considerable unmet needs in the region and where there were existing innovation procurement initiatives that could be used to inspire and motivate.
The associate hospital identified is the Zala County Hospital which was established in 1848, and was awarded hospital of the year in 2005. The hospital has over 1000 beds and cares for 41000 in-patients each year.
Following a series of meetings and presentations the Hospital was helped to undertake a review of issues / opportunities and identify unmet needs. One problem that emerged strongly from nursing staff was bed and mattress provision and pressure care management. A number of medium and short--‐term supply requirements were highlighted by staff.
Following a meeting of the project team with the national and project coordinator, the following narrative was developed to describe the existing situation and emerging outcome based requirement.
The beds in the hospital have been acquired over a long period of time and are of different shapes, sizes and varying states of repair with only a small number of beds allowing transport of patient to and from theatre.
The mattresses are of three types. The vast majority are medium density uncovered foam, with some foam mattresses designed to aid the management of pressure sores, and 2 dynamic mattresses for use in intensive care. The policy is that mattresses are transported for steam cleaning following fatalities and use by patients with infectious disease or as required. The mattresses are intended to be used with mattress protectors that are changed each time a new patient arrives or more frequently as required. Pressure care management is delivered manually by nurses through turning and mobilization.
The review highlighted a number of shortcomings in the current situation that are at risk of compromising patient comfort and care and result in efficient use of clinical staff time:
There are insufficient mattresses protectors (most recent estimated was 200 less than required); The mattress protectors currently used become unusable after a single wash so the number of covers required is growing; At the time of the review 80 mattress protectors were identified as unfit for purpose and at the end of their life and a further 720 were approaching the end of their life; The existing mattress protectors do not fit the bed tightly leading to wrinkles that contribute to development of pressure sores; The mattress protectors require two nurses to fit them.
The mattresses do not fit the beds in many cases and are unstable contributing to patient falls; After steam cleaning the mattresses the condition of the foam mattresses deteriorates becoming friable and hardened; The lack of pressure care management mattresses is a significant contributing factor to the development, and slow recovery, of pressure sores; 50% of the mattresses are at or near the end of the life
Beds without protective barriers, together with poorly fitting and damaged mattresses are a significant factor in patient falls
Nurses report that there is an increasing incident of pressure sores on arrival of patients in hospital which compromises well being and recovery of patients and increased hospital stays; it is unclear how effective the ‘thorn’ foam mattresses are. The project team has identified the following immediate requirement (draft): The hospital needs a solution to provide protection to existing foam mattresses that delivers the following outcomes:
The hospital would also consider the procurement of mattresses with integral protectors where these could be shown to be cost effective and affordable based on whole life costs.
The project team will continue to clarify the unmet need and requirement ahead of a market consultation exercise following the Forward Commitment Procurement approach. They will also meet with finance staff to discuss the budget situation and present the idea of whole-life costing. For example, the current bed situation leads to patient falls and this has a cost that is not considered in the cost of mattresses and associated equipment. Similarly, poor mattresses and covers lead to problems with pressure sores which compromise patient recovery.
Contact details for the leader led project coordinator Oliver Komma
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