improvement teams and in some areas has been shown to reduce the rate of pressure sores by a third (e.g. from over 20% to 7%).
The second example illustrates an area where again there is clear research evidence, but which is not being implemented in practice. In the management of leg ulcers, research highlights compression bandaging as an effective treatment and in the UK this research is summarised in the form of a national clinical guideline. However, an audit in one health service region indicated that over 60 different treatments were being used in the care of leg ulcers, many of which were proven to be ineffective. This illustrates a problem at the implementation stage and various strategies are needed to improve the uptake of evidence in practice, including: education; the development of professional knowledge and expertise; adaptation of national clinical guidelines to make them more applicable; and the provision of resources at a clinical level to support the change process.
Future challenges
As these examples illustrate, both research and quality improvement have an important contribution to make to improving the quality of patient care. However, if we are committed to promoting quality improvement in health care and ensuring that practice is based on evidence of what works, or is known to be most effective, there are a number of issues and challenges we need to consider. These include: strengthening the existing evidence base and using quality improvement to generate new questions for research; ensuring that existing evidence is made accessible so that it can effectively inform local quality improvement activities; and enabling staff to
