Integrating QSEN into Your Curriculum Iowa Healthcare Educators Conference June 21-22, 2012

1. Anita M. Stineman, PhD, RN Jill Gaffney Valde, PhD, RN Integrating QSEN into Your CurriculumIowa Healthcare Educators ConferenceJune 21-22, 2012

2. Objectives • Discuss the relationship of the QSEN Competencies and teaching students to provide quality patient care. • Develop activities for learning environments that will enhance student retention of the QSEN Competencies.

3. QSEN Competencies • Patient-Centered Care • Safety • Teamwork and Collaboration • Quality improvement (QI) • Informatics • Evidence-based practice (EBP)

4. Sue Sheridan’s Story • http://www.ahrq.gov/video/teamsteppstools/ts_Sue_Sheridan/Sue_Sheridan-400-300.html

5. Patient-Centered Care What does this mean to you? • 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. www.qsen.com

6. How do we incorporate this Competency? • Role of patient in deciding care • “What is the most important thing for you to have happen today?” • Doing with vs. doing to • Family Involvement

7. Patient –Centered Care • White boards • Patient Teaching: Teach Back www.nchealthliteracy. org/toolkit/tool5.pdf • Bed side Reports • Rounding as clinical group vs. end of clinical classroom conference

8. Safety • Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. www.qsen.com

9. Integration into Practice One Minute Safety Checklist • Prioritize safety concerns (ABC’s of Physiologic Safety) • Complete form – can be shared with staff/peers www.qsen.org K. Amer, 2007 “What is your priority safety concern for your assigned patient today?”

10. National Patient Safety Goals • Discuss NPSG and their purpose • http://www.jointcommission.org/assets/1/6/NPSG_EPs_Scoring_HAP_20110706.pdf • Select 1-3 goals to focus on each week • Students observe how goal is addressed/implemented on their unit

11. Error Prevention Error - “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” (IOM, 1999) Focus on how we can prevent errors! http://www.ihi.org/offerings/IHIOpenSchool/resources/Pages/default.aspx

12. Clinical Activity • Provide a scenario in which an error occurs. • Teams analyze the error • Compare different solutions and how team decided approach

13. Teamwork and Collaboration • Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. www.qsen.com

14. TeamSTEPPS • A powerful solution to improving patient safety • An evidence-based teamwork system to improve communication and teamwork skills

15. TeamSTEPPS Key Principles • Team Structure • Leadership • Situation Monitoring http://www.qsen.org /search_strategies.php ?id=89 • Mutual Support • Communication

16. Situation Monitoring “Watching each other’s back”

17. Communication

18. Communication I-SBAR-R

19. Quality Improvement (QI) • 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. www.qsen.com

20. Culture of SafetyJust Culture • ‘Near Miss’ • ‘Fix the Problem, Not the Blame’ • Human Error • At- Risk Behavior • Reckless Behavior

21. A Quality Improvement Model PDSA • Plan • Do • Study • Act

22. Quality ImprovementTools • Run Chart and Control Charts • Flow Chart • Root Cause Analysis/ Fishbone diagram/ Cause Effect • Ask 5 Times

24. http://www.qsen.org/search.php?id=51&text=flow%20chart - Tools Flow Chart

25. Fishbone Diagram - Falls Policy on staffing ratios Wet, slippery floors Patient Falls Lack of staff training Limited number of wheel chairs

26. Informatics • Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. • EMR • Standardized Language www.qsen.com

27. Information Literacy E-Patients • Authority/source • Accuracy • Objectivity/content • Currency/timeliness • Structure/access http://hsl.lib.umn.edu/biomed/help/evaluating-web-resources University of Minnesota

28. Information Literacy Google Scholar vs. Wikipedia vs. CINAHL http://www.qsen.org/teachingstrategy.php?id=69 Jarzemsky & Voge www.QSEN.org

29. Medical Apps

30. Evidence-based practice (EBP) • Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. www.qsen.com

31. Develop EBP Activities Nursing Quality Indicators • Pressure ulcers • Falls • Restraint use • Patient satisfaction • Hospital-acquired infection (HAI) • Unit/setting specific • Policy/Procedure • Care bundles/protocols

32. Design EBP Activities • Identify specific EBP Guideline appropriate to your unit • Procedure/Protocol – • 1.Work-arounds (www.qsen.org Day & Smith, 2007) • 2. locate research article; compare & contrast with agency’s (www.qsen.org Tesch, 2008)

33. Design EBP Activities • Group Activity -identify problem and research intervention(www.qsen.org Ironside, 2007) • Provide opportunity to present process to students, staff and faculty

34. Places to Look for EBP • AHRQ Guideline Clearinghouse • www.guideline.gov • Cochrane Collaborative Library • www.cochrane.org/index0.htm • RNAO Nursing Best Practice Guidelines • www.rnao.org/Page.asp?PageID=861&SiteNodeID=133

35. Additional Resources: Josie King and Lewis Blackman video – http://www.qsen.org (Look under Faculty Resources – Videos) TeamSTEPPS: http://teamstepps.ahrq.gov/ Fishbone Diagram Template: http://www.qsen.org/teachingstrategy.php?id=171