Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

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  • Nataliya Brima
  • Nick Sevdalis
  • K Daoh
  • Betsy Deen
  • Thaim Kamara
  • Haja Wurie
  • Andrew Leather

Colleges, School and Institutes


There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone.

This project was co-developed and co-designed by in-country stakeholders and UK based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixedmethod, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases – 1) pre-implementation(project set up and review of hospital relevant policies and forms), 2) intervention implementation (awareness drive, training package, audit and feedback), and 3) evaluation of a) the feasibility of delivering the intervention and capturing implementation and process outcomes, b) the impact of implementation strategies on the adoption, integration and uptake of the intervention using implementation outcomes, c) the intervention’s effectiveness For improving nursing in this pilot setting

We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone.


Original languageEnglish
Article number33
JournalPilot and Feasibility Studies
Publication statusPublished - 27 Jan 2021


  • surgical patient records, nursing notes, surgical patients, Quality improvement (QI) intervention, implementation outcomes, PDSA, Evaluation of outcomes