Improvements in the quality of co-ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes

Aim. To study the effect of implementation of the Resident Assessment Instr ument (RAI) on the quality of co-ordination of nursing care in Dutch nursin g homes. Background. The Resident Assessment Instrument (RAI) was designed to improv e the quality of care and quality of life in nursing homes. Until now, only noncontrolled studies on the effects of implementation of the RAI have bee n carried out. Design/methods. Quasi-experimental; intervention wards with RAI compared wi th wards with no intervention. We used the co-ordination of nursing care in strument, which includes measures for case history, care plan, end of shift report, communication, patient allocation and patient report. The scores o n these scales represent the quality of nursing procedures on a ward. The m easurements were done 1 month before and 8 months after RAI-implementation in 18 wards in 10 nursing homes in the Netherlands. Results. Out of 348 somatic patients on the participating wards who met the inclusion criteria and signed an informed consent, 278 could be measured a t the first and 218 at the second data collection. 175 residents could part icipate twice. We used a meta-analysis technique to study the mean differen ces between eight couples of RAI/control wards before and after the interve ntion. The mean difference scores showed significant positive improvement i n the RAI group for case history, there were minor (not statistically signi ficant) improvements for all other scores and the total score. These result s are encouraging especially in light of the fact that RAI-implementation i n all the experimental wards did not proceed according to plan, owing to st affing and software problems. Conclusions. We conclude that the RAI has the potential to improve the qual ity of co-ordination of care in nursing homes.