NUR 320 GROUP 3 PRESENTATION: NURSING PRACTICE STANDARDS

1. NUR 320 GROUP 3 PRESENTATION: NURSING PRACTICE STANDARDS By: Christin Barnaby, Denise Cooney, Tracy gregory, lisapashak, & tonyasuckley

2. Practice Standards Organizations • Joint Commission on Accreditation of Healthcare Organizations • Institute of Medicine • Quality and Safety Education for Nurses • American Nurses Association • Healthy Work Environments

3. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) BY Tonya Suckley, RN

4. Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Vision : All people always experience the safest, highest quality, best-value health care across all settings. The mission and vision statements of the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, providing a universal standard within the healthcare system.

5. What is it? • An independent, not-for-profit organization, The Joint Commission, or JCAHO is the nation's oldest and largest standards-setting and accrediting body in health care. • It is governed by a thirty-two member Board of Commissioners that includes physicians, administrators, nurses, employers, a labor representative, health plan leaders, quality experts, ethicists, a consumer advocate and educators. The Board of Commissioners brings to the Joint Commission diverse experience in health care, business, and public policy. • The Joint Commission’s corporate members are the American College of Physicians, the American College of Surgeons, the American Dental Association, the American Hospital Association, and the American Medical Association. The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx

6. Who created it and why? • The Joint Commission History Timeline of Development: pre-establishment to foundation • 1910 Ernest Codman, M.D, proposes the “end result system of hospital standardization.” Under this system, a hospital would track every patient it treated long enough to determine whether the treatment was effective. If treatment was not effective, the hospital would then determine why, so that future cases could be successfully treated . • 1913 American College of Surgeons (ACS) is founded at the urging of Franklin Martin, M.D., a colleague of Dr. Codman. The “end result” system becomes an ACS stated objective. • 1917 Supported by a grant from Carnegie Foundation, the ACS develops the Minimum Standard for Hospitals. Requirements fill one page. • 1918 The ACS begins on-site inspections of hospitals. Only 89 of 692 hospitals surveyed meet the requirements of the Minimum Standard. • 1926 The first standards manual is printed consisting of 18 pages. • 1950 The standard of care improves over time and more than 3,200 hospitals achieve approval under the program. • 1951The American College of Physicians, The American Medical Association, the American Hospital Association, and the Canadian Medical Association join with ACS as corporate members to create the Joint Commission on Accreditation of Hospitals (JCAH), an independent, not-for-profit organization. The primary purpose is to provide voluntary accreditation. The corporate members appoint the Board of Commissioners, the JCAH’s governing body. The Joint Commission. (2012) History of The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/history.aspx

7. What do they do? • The Joint Commission standards address the organization’s level of performance in key functional areas, such as patient rights, patient treatment, medication safety and infection control. • The standards focus on setting expectations for an organization’s actual performance and for assessing its ability to provide safe, high quality care. • If an organization meets the performance expectations, and does them well, it is likely that its patients will experience good outcomes. • Standards are developed in consultation with health care experts, providers, measurement experts, purchasers, and consumers. • The Joint Commission provides accreditation services for the following types of organizations: • General, psychiatric, children’s and rehabilitation hospitals • Critical access hospitals • Home care organizations, including medical equipment services and hospice services • Nursing homes and other long term care facilities • Behavioral health care organizations, addiction services • Ambulatory care providers, including group practices and office-based surgery practices • Independent or freestanding clinical laboratories The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx

8. What do they do? • Accreditation is given and maintained through an on-site survey process • The survey process is data-driven, patient-centered and focused on evaluating actual care processes. • The survey objectives are to evaluate the organization, and to provide education and “good practice” guidance that will help staff continually improve the organization’s performance. • The Joint Commission evaluates and accredits more than 19,000 health care organizations and programs in the United States. • To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. (Laboratories must be surveyed every two years.) • The Joint Commission also awards Disease-Specific Care Certification to organizations that provide disease-specific care and chronic care services, and an advanced level of certification is offered for: chronic kidney disease, chronic obstructive pulmonary disease, heart failure, inpatient diabetes and primary stroke centers. The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx

9. Benefits of Accreditation • The benefits of Joint Commission accreditation include: • Helps organize and strengthen patient safety efforts • Strengthens community confidence in the quality and safety of care, treatment and services • Provides a competitive edge in the marketplace • Improves risk management and risk reduction • May reduce liability insurance costs • Provides education to improve business operations • Provides professional advice and counsel, enhancing staff education The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx

10. Benefits of Certification • The benefits of Joint Commission certification include: • Improves the quality of patient care by reducing variation in clinical processes • Provides a framework for program structure and management • Provides an objective assessment of clinical excellence • Creates a loyal, cohesive clinical team • Promotes a culture of excellence across the organization • Facilitates marketing, contracting and reimbursement • Strengthens community confidence in the quality and safety of care, treatment and services The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx

11. How JCAHO influences My Nursing PracticeBY Tonya suckley, RN • As a Critical Care Float nurse for St. Joseph Mercy Oakland, a JCAHO accredited hospital, I am fully guided in my nursing practice by the patient safety goals and practice standards implemented to maintain accreditation by JCAHO. My hospital is also certified as a Level 2 Stroke Center, and currently seeking Level 2 Trauma Certification. Since I float AICU, CCU, ER, and Rapid Response Team, I must be extremely thorough in following all protocols and practice standards implemented for the care of stroke and trauma patients. These ensure the best clinical outcomes for the patient, as well as maintain our certifications in these areas. I am also certified for Vascular Access and insert Peripherally Inserted Central Lines, or PICCs at the patient bedside using ultrasound guidance and sterile technique. This procedure requires me to follow strict protocol in patient identification, procedure time-out, infection prevention in use of complete sterile technique, • When caring for my patients, I follow the National Patient Safety Goals established by JCAHO. These were implemented to reduce sentinel events, and to give the utmost quality of safe and preventative care to our patients: • Identify patients correctly-use at least 2 identifiers- match patient to correct blood, medicine, treatment • Improve the effectiveness of communication-write down, read back, confirm all telephone, verbal orders and critical test results • Use medications safely-label all meds/solutions, including on/off the sterile field, take extra care with patients given anticoagulants, maintain and communicate accurate medication information • Prevent infections- Good hand hygiene, thoroughly wash your hands prior to entering and leaving patient rooms, and prior to patient contact. Also help reduce surgical site infections, as well as device associated infections- IV, foley, ventilator • Identify safety risks in the patient population- Identify patients at risk for suicide, abuse/neglect, or fall risk • Universal Protocol-Bedside, surgical, and invasive procedures: Verification of patient, procedure, site/side, mark the procedure site, conduct a time-out prior to procedure • Do not use prohibited abbreviations- U-write unit, IU, Q.D.- write out daily, MS- write out Morphine. These have been prohibited due to the mistakes made in deciphering them that have been detrimental or potentially harmful to patients.

12. The Institute of Medicine (IOM) BY Tracy Gregory, RN

13. IOM’s Clinical Practice Guidelines • “The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public” • First developed Clinical Practice Guidelines in 1990’s with frequent updates- • Last updated 2011 • Institute of Medicine of the National Academies. (2012, Jan 18). About the IOM. Retrieved from http://www.iom.edu/About-IOM.aspx

14. Why Update ? • “The U.S. healthcare environment has evolved dramatically since the IOM’s early guideline reports. This committee was challenged to determine how that evolution has affected and should affect the CPG development process, exploring which prior recommendations are no longer relevant, where progress has been made, and what new problems have arisen” (pg. 21). • “Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” (Pg. 4). • Instead of giving a one size fits all list of CPG, the IOM determined a better course of action would be to give groups guidelines for creating CPG’s that will be specific and research driven. • Institute of Medicine of the National Academies. (2011). Clinical practice guidelines we can trust: Committee on standards for developing trustworthy clinical practice guidelines. Washington, DC: The National Academies Press.

15. What are the IOM current recommendations? • “Establishing Transparency • The processes by which a CPG is developed and funded should be detailed explicitly and publicly accessible. • Management of Conflict of Interest (COI) • All COI of each GDG member should be reported and discussed by the prospective development group prior to the onset of his or her work. • Guideline Development Group Composition • The GDG should be multidisciplinary and balanced, comprising a variety of methodological experts and clinicians, and populations expected to be affected by the CPG. • Clinical Practice Guideline–Systematic Review Intersection • Clinical practice guideline developers should use systematic reviews that meet standards set by the Institute of Medicine’s Committee on Standards for Systematic Reviews of Comparative Effectiveness Research.

16. Recommendations Continued • Establishing Evidence Foundations for and Rating Strength of Recommendations • An explanation of the reasoning underlying the recommendation, Including: a clear description of potential benefits and harms; a summary of relevant available evidence (and evidentiary gaps), description of the quality (including applicability), quantity (including completeness), and consistency of the aggregate available evidence; an explanation of the part played by values, opinion, theory, and clinical experience in deriving the recommendation. • Articulation of Recommendations • Recommendations should be articulated in a standardized form detailing precisely what the recommended action is, and under what circumstances it should be performed.

17. Recommendations Continued • External Review • External reviewers should comprise a full spectrum of relevant stakeholders, including scientific and clinical experts, organizations (e.g., health care, specialty societies), agencies (e.g., federal government), patients, and representatives of the public. • Updating” (pgs. 6-8). • The CPG publication date, date of pertinent systematic evidence review, and proposed date for future CPG review should be documented in the CPG. • Institute of Medicine of the National Academies. (2011). Clinical practice guidelines we can trust: Committee on standards for developing trustworthy clinical practice guidelines. Washington, DC: The National Academies Press.

18. How the IOM affects My PRACTICEBY Tracey Gregory, RN • To be honest I don’t think about the IOM in my daily practice. • I do read their updated reports on clinical practice as they pertain to geriatrics or my other clinical interests such as OB and at times guide my practice. • I am interested in becoming a member of IOM as I believe they make important contributions to the medical field. • My employer has created CPG’s prior to the newest IOM recommendation for creation therefore the CPG’s we use need be reviewed to ensure they are trust worthy. • I plan to bring up the IOM’s recommendations and the fact that our CPG’s need to be reviewed at our next nurses meeting. I hopeful my organization would be receptive to reviewing/updating our current CPG’s.

19. QUALITY & SAFETY EDUCATION FOR NURSES (QSEN) BY CRISTIN BARNABY, RN

20. HISTORY OF QUALITY & SAFETY EDUCATION FOR NURSES-- • QUALITY & SAFETY EDUCATION FOR NURSES (QSEN) was started in October, 2005.1 • QSEN was funded by the Robert Wood Johnson Foundation.1 • QSEN was started in phases.1 • Phase I & 2 were led by Linda Cronenwett and Gwen Sherwood1 • Phase 3 was led by L. Cronenwett and G. Bednash1 • Phase 3 was led by 1. Quality and safety education in nursing. (2012). Retrieved from QSEN.org

21. WHAT HAPPENED IN EACH PHASE? Phase 1 and 2 • Competencies developed1 • Pilot curriculum developed1 Phase 3 • Widespread sharing of innovation1 • Increased expertise by faculty1 • Increase in publications1 Phase 4 • Textbook publication1 1. Quality and safety education in nursing. (2012). Retrieved from QSEN.org

22. WHAT QSEN DOES • “Assist[s]…educators who are eager to discover effective ways to promote student learning that will prepare them for becoming full partners in the work of improving patient safety and healthcare systems.”1 • “Draft[s] statements about the knowledge, skills and attitudes that should be developed for each competency during pre-licensure education.”2 • Competency development • “Provides a systematic pedagogical structure for course redesign and content to prepare nurses to value quality and safety in caring for patients.”3 Quality and safety education in nursing. (2012). Retrieved from QSEN.org Cronenwett, L., & Sherwood, G. (2007). Quality and safety education for nurses. Leader to leader: Nursing regulation and education together, Spring, Retrieved from https://www.ncsbn.org/Leader_to_Leader_Spring07.pdf Brady, D. S. (2011). Using Quality and Safety Education for Nurses (QSEN) as a Pedagogical Structure for Course Redesign and Content. International Journal Of Nursing Education Scholarship, 8(1), 1-18. doi:10.2202/1548-923X.2147

24. COMPETENCIES DEFINED • PATIENT-CENTERED CARE: “Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.”1 • TEAMWORK & COLLABORATION: “Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.”1 • EVIDENCE BASED PRACTICE: "Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.”1 • QUALITY IMPROVEMENT: "Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.”1 • SAFETY: "Minimizes risk of harm to patients and providers through both system effectiveness and individual performance."1 • INFORMATICS: "Use information and technology to communicate, manage knowledge, mitigate error, and support decision making."1 1. Quality and safety education in nursing. (2012). Retrieved from QSEN.org

25. HOW QSEN’S COMPETENCIES AFFECT MY PRACTICE BY CRISTIN BARNABY, RN I WORK IN AN AMBULATORY CLINIC THAT SPECIALIZES IN INTERNAL MEDICINE I CURRENTLY WORK AS A STAFF NURSE TRIAGE PATIENTS IN THE CLINIC AND THROUGH TELEPHONICS. AS A NEW GRADUATE REGISTERED NURSE MY PRACTICE IS MOTIVIATED BY NEW EDUCATION AND PRACTICE STANDARDS. THE BIGGEST WAY QSEN HAS AFFECTED ME IS THROUGH THEIR EMPHASIS ON EVDIENCE BASED PRACTICE. IN MY PLACE OF EMPLOYMENT I AM ENCOURAGED TO HELP INNOVATE AND ENCOURAGE CHANGE; THE EASIEST WAY TO DO THIS IS WITH EVIDENCE ON MY SIDE. CURRENTLY I AM WORKING ON DEVELOPING A COUMADIN CLINIC FOR MY FACILITY WITH THE HELP OF ONE OF MY PEERS. WE ARE RESEARCHING DATA BASED ON OTHER NURSE RUN CLINICS. QSEN HAS TAUGHT ME HOW TO LOOK FOR QUALITY AND RELIABLE RESOURCE TO DEVELOP AND PROPOSE A CREDIBLE STANDARD.

26. AMERICAN NURSES ASSOCIATION (ANA) BY LISA PASHAK, RN

27. HISTORY OF AMERICAN NURSES ASSOCIATION-- • The American Nurses Association or ANA was created in 1896. It has been around for over 100 years. • The ANA was formed by nursing profession alumnae. It was originally called The Nurses Associated Alumnae. • Previously there was no laws governing nurses. WHAT IS IT ???? WHO CREATED IT?? WHY WAS IT MADE?? HOW LONG??

28. WHAT THE ANA DOES?? • The ANA promotes a base of high standards for nursing practice. • It promotes the economic and general welfare of nurses in their work environment. • It projects a realistic, positive view of nursing and lobbies Congress and regulatory agencies about health care issues affecting nurses and the general public. • It offers services to nurses for: continuing education, provides professional standards, offers conferences, and has governmental relations.

30. STANDARDS OF PROFESSIONAL PERFORMANCE • QUALITY OF CARE • PERFORMANCE APPRAISAL • EDUCATION • COLLEGIALITY • ETHICS • RESOURCE UTILIZATION

31. CLOSING POINTS OF AMERICAN NURSES ASSOICATION • The ANA believes that the nursing profession should be based upon a usable and clear Code of Ethics. • The ANA is committed to addressing the complex ethical and human rights issues which all nurses face everyday. • The ANA also wrote a “Bill of Rights for Professional Nurses” which lists the rights that Registered Nurses are entitled to in the workplace. • These rights help nurses to be good advocates to their patients and themselves.

32. HOW DO THE ANA STANDARDS OF PRACTICE AFFECT My PracticeBY LISA PASHAK, RN I WORK IN AN ACUTE CARE SETTING IN A HOSPITAL IN WEST MICHIGAN. I CURRENTLY WORK AS A FLOAT RN BUT ALSO HAVE 18 YEARS EXPERIENCE WORKING IN THE CRITICAL CARE AND TELEMETRY UNIT. MY DAILY PRACTICE IS AFFECTED BY THE ANA AND ITS STANDARDS OF NURSING PRACTICE AS WELL AS ITS CODE OF ETHICS FOR NURSING. MY HOSPITAL BASES ITS STAFFING GUIDELINES ON NURSING PRACTICE AS WELL AS ITS LIST OF NURSING RELATED POLICIES AND PROCEDURES. MY PLACE OF EMPLOYMENT PROVIDES ITS STAFF WITH OPPORTUNITIES FOR CONTINUING EDUCATION CREDITS AS WELL AS UPDATES US ON THE LATEST PROCEDURES AND STANDARDS IN NURSING. MY PERSONAL PRACTICE IS AFFECTED BY THE ANA BECAUSE I AM ALWAYS ADVOCATING FOR MY PATIENTS SAFTEY, AS WELL AS THE SAFTEY OF MY FELLOW STAFF MEMBERS AND MYSELF.

33. Healthy Work Environments (HWE) BY Denise Cooney, RN

34. Healthy Work Environments (HWE) • In 2001, The American Association of Critical-Care Nurses was given the task of creating healthy work environments. The result of this was the publication of Standards for Establishing & Sustaining Healthy Work Environments. • The need for HWE was supported by evidence that an unhealthy work environment “contributes to medical errors, ineffective delivery of care and conflict & stress among health professionals.” (AACN, 2005)) • It also was needed to “ensure patient safety, enhance staff recruitment & retention and maintain an organization’s financial viability.” (AACN, 2005))

35. 6 Standards of HWE • Skilled Communication • True Collaboration • Effective Decision Making • Appropriate Staffing • Meaningful Recognition • Authentic Leadership

36. Healthy Work Environment • “The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and where patient care is delivered.” (Pross, 2010) • The staff needs to feel support in order to engage in any culture change.

37. Healthy work environments are an influence to the whole spectrum of healthcare. The patients benefit from less errors in their care The nurses benefit from less conflict and stress The administration benefits from a financial standpoint HOW THE HWE AFFECT MY PracticeBY Denise Cooney, RN

38. REFERENCES • ANA Website, (2012, November). Retrieved from http://ana.nursingworld.org. • Brady, D. S. (2011). Using Quality and Safety Education for Nurses (QSEN) as a Pedagogical Structure for Course Redesign and Content. International Journal Of Nursing Education Scholarship, 8(1), 1-18. doi:10.2202/1548-923X.2147 • Cronenwett, L., & Sherwood, G. (2007). Quality and safety education for nurses. Leader to leader: Nursing regulation and education together, Spring, Retrieved from https://www.ncsbn.org/Leader_to_Leader_Spring07.pdf • Quality and safety education in nursing. (2012). Retrieved from QSEN.org • Lippencott Manual of Nursing Practice. (2010). Chapter 2 Standards of Care, Ethical and Legal Issues. • Tabers Encyclopedic Medical Dictionary. (2009) 21st edition. • Tweten, C. (n.d.). Code of Ethics for Nursing. Retrieved November 27, 2012. from http://www.ehow.com • Institute of Medicine of the National Academies. (2012, Jan 18). About the IOM. Retrieved from http://www.iom.edu/About-IOM.aspx • Institute of Medicine of the National Academies. (2011). Clinical practice guidelines we can trust: Committee on standards for developing trustworthy clinical practice guidelines. Washington, DC: The National Academies Press. • American Association of Critical Care Nurses. (2005). AACN Standards for Establishing and Sustaining Healthy Work Environments. Retrieved from: http://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf • Pross, S. (2010, January). Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit . The Online Journal of Issues in Nursing, 15(1). Retrieved from http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Growing-Nurse-Leaders.aspx • The Joint Commission. (2012) History of The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/history.aspx • The Joint Commission. (2012) Facts about The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/fact_sheets.aspx