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 Instrument (RAI) on the quality of co-ordination of nursing care in Dutch nursing homes. Background. The Resident Assessment Instrument (RAI) was designed to improve 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 been carried out. Design/methods. Quasi-experimental; intervention wards with RAI compared with wards with no intervention. We used the co-ordination of nursing care instrument, which includes measures for case history, care plan, end of shift report, communication, patient allocation and patient report. The scores on these scales represent the quality of nursing procedures on a ward. The measurements 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 at the first and 218 at the second data collection. 175 residents could participate twice. We used a meta-analysis technique to study the mean differences between eight couples of RAI/control wards before and after the intervention. The mean difference scores showed significant positive improvement in the RAI group for case history, there were minor (not statistically significant) improvements for all other scores and the total score. These results are encouraging especially in light of the fact that RAI-implementation in all the experimental wards did not proceed according to plan, owing to staffing and software problems. Conclusions. We conclude that the RAI has the potential to improve the quality of co-ordination of care in nursing homes.