• Jenny M Parr, Jeanette Bell, and Jane Koziol-McLain.
• Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand.
• J Clin Nurs. 2018 Jun 1; 27 (11-12): 2360-2372.

Aims And ObjectivesThe project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care.BackgroundFeedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board.DesignA general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care.MethodsFive phases were used to explore the evidence, and design and test a measurement and improvement framework.ResultsNine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result.ConclusionThe PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care.Relevance To Clinical PracticeDelivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements.© 2018 John Wiley & Sons Ltd.

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