Institute of Medicine

1. Institute of Medicine Nurs 320 Group 9 Jennifer Ames Katie Laurain Holly Leveille Maia Novak Erin Swartz

2. What is the IOM? • “an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public” (Institute of Medicine of the National Academies). • The IOM provides information about health and health care to the public • The IOM is the health branch of the National Academy of Sciences which was created in 1970

3. Membership • 1900 members • Each year 70 new members and 10 foreign associates are elected. • Elected based on professional achievement, excellence, and willingness to participate in IOM’s mission. • Not all members are health professionals. Members include: social and behavioral sciences, law, administration, engineering, and humanities field. • All members serve on a pro bono basis.

4. Purpose of IOM • Their goal is to provide reliable evidence to the public and the government so that they can make informed decisions about healthcare • The IOM conducts many different studies aimed at improving overall health • The IOM has several committees, forums, and roundtables to “facilitate discussion, discovery, and critical, cross-disciplinary thinking” (Institute of Medicine of the National Academies)

5. Research process • Members conduct research to improve the nation’s health. • A sponsor asks for the IOM’s independent, unbiased research with objective and straightforward answers. • Although the studies are sponsored by an agency, either government or private sector, research is conducted to privately to avoid any external influence. • Check and balances are in place to maintain integrity. • A second independent external review is conducted to ensure quality and provide objective results.

6. Initiatives started by the IOM • Recommended daily dietary allowances • Proper use of antibiotics to avoid the development of antibiotic resistant organisms • “To Err is Human: Building a Safer Health System” • Best Care at Lower Cost the Path to Continuously Learning Health Care in America

7. To Err is Human • A comprehensive report in which a multifaceted approach can be taken to reduce preventable medical errors. • Goal of the report is a 50 percent reduction in errors over the next five years. • A balance between regulatory measure and market-based initiatives were suggestions. • Between 44,000-98,000 people die as a result of medical errors. • Costs estimate between $17-29 billion per year.

8. To Err is Human • Errors are mostly caused by faulty systems, processes, and conditions that contribute to mistakes. • Errors include: adverse drug events, improper transfusions, surgical injuries and wrong site surgery, suicides, restraint related injuries, falls, burns, pressure ulcers, and mistaken patient identities. • Back in 1999 most third-party purchasers of health care provided little financial incentive for healthcare organizations and providers to improve safety and quality.

9. Strategies for improvement • Establishing a national focus to create leadership, research, tools, and protocols to enhance the knowledge base about safety. • Identifying and learning from errors by developing a nationwide public mandatory reporting system and by encouraging health care organizations and practitioners to develop and participate in voluntary reporting systems. • Raising performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care. • Implementing safety systems in health care organizations to ensure safe practices at the delivery level.

10. Michigan Response to the report • On a state level, an organization entitled Michigan Health & Hospital Association (MHA) has tackled many of these topics through their Keystone, Health Engagement Network (HEN), and Patient Safety Organization (PSO) initiatives. • In 2003 this organization “has supported and guided Michigan hospitals in identifying best practice and pioneering patient safety interventions that have reduced infections and medical errors.” • These interventions have saved thousands of lives through reducing medical errors, cutting health care costs, and implementing quality improvement measures through voluntary collaborative efforts. • In 2009 the PSO was launched to improve patient safety by collecting data from multiple health systems to understand accidental harm and share what was learned and establish best practices in an open environment. • Currently the successes of Michigan are being modeled and adopted across the nation.

11. IOM Future of Nursing • In 2010, the IOM issued this report emphasizing new guidelines for nursing practice • This initiative was started in 2008 in response to talk about health care reform • The IOM recognizes that the demand on the health care system will increase greatly with the passing of new health care legislation in March 2010 that will provide coverage to 32 million Americans and nurse play a key role in improving health care

12. Four Key Messages • The report contained four key messages for nursing practice: • Nurses should practice to the full extent of their education & training. • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. • Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. • Effective workforce planning and policy making require better data collection and improved information infrastructure.

13. What does this mean for nurses? • Nurses practice within a small multidisciplinary medical office • Prevention, wellness, and chronic care management • Evidence based algorithms used by nurses • Coaching and counseling • Affordable Care Act will give $200 million from 2012 to 2015 to hospitals to pay for the clinical training of Advance Practice Registered Nurses

14. What this means for nurses • APRNs would be funded to provide primary and preventative care, transitional care, and chronic care management • 80% BSN educated by 2020 • Double the number of nurses with doctorates by 2020 • Encourage and develop leadership skills and other competencies • Collaborate in policy making by serving on policy making boards

15. Practice Standard Influence/Relation to my nursing practice (Jennifer) • In my current practice area of nursing, Quality and Emergency, The IOM has influenced my nursing practice by undertaking an initiative to transform the role of nursing to meet the demands of the Affordable Care Act (ACA). • 2008 Robert Wood Johnson Foundation and IOM partnered to assess the need to transform the nursing profession to make quality care accessible, promote wellness and disease prevention, and provide compassionate care. • In 2010 provided blue prints for nursing at the national, state, and local levels to met the demands of the ACA. • Evidence my practice has been influenced by these key messages • I am currently practicing in a department that typically requires a BSN already. • Enrolled in a higher education program with intentions to continue onto a MSN. • Currently serve on various committees: Patient Safety, Sepsis, and Quality Improvement Council, in which I work with physicians, lab directors, coders, and pharmacists to rewrite policies to improve patient care. • Key contributor to ensure meaningful use and value based purchasing requirements are being met on a daily basis. The Future of Nursing: Leading Change, Advancing Health (2011)

16. Practice Standard Influence/Relation to my nursing practice(continued Jennifer) • The report has basically established my area of practice as a nurse in the quality department to ensure safe care. • I am in charge of oversight of the reporting performance standards to improve patient care and safety to within the hospital and to various state and national organizations. • I serve on committees and implement changes in protocol to ensure safe practices within the hospital. • The committees include adverse drug events, falls, pressure ulcers, wrong site surgeries, hospital acquired infections, amongst others.

17. Practice Standard Influence/ Relation to my nursing practice (Maia) • In my current practice area of nursing, Pediatric Nursing, The IOM has influenced my nursing practice by helping me understand what I do and why it is important. • Evidence my practice has been influenced by these key messages • The IOM influences my nursing practice every day that I work. • Every day I use evidence based practices. • -some examples include following up to date policies and procedures and ensuring sterile technique for certain procedures. • -I provide unbiased care to my patients, similar to how the IOM provides unbiased information and advice to policy-makers, professionals, and leaders • -Just like the IOM, I would like to improve health in our country and in my community. I plan to volunteer more of my time to help raise money of my hospital and other health organizations in the area. • -I am gaining knowledge and skills by completing my BSN • -I currently attend Shared Leadership meetings which help me become informed about new changes on my floor

18. Practice Standard Influence/ Relation to my nursing practice (continued Maia) • Questioning orders helps decrease medical errors. We are taught that if something doesn’t make sense or appropriate to ask clarifying questions. We are also required to have a second nurse double check certain medications before they are administered. Every time I give a medication that is new to me, I have another nurse look it over and this helps them become familiar with new medications as well.

19. Practice Standard Influence/ Relation to my nursing practice (Holly) • “Most coalitions have focused on, and already made progress toward, the IOM’s recommendation that 80 per­cent of the nursing workforce have a BSN degree by 2020” (Institute of Medicine, 2012). • While the IOM recommends that 80% of the work force have their BSN degrees by 2020, I have decided to work on mine right after completing my ADN program. Education has always been an important part of my life and I enjoy constantly learning. • I can see the recommendations of the IOM in the emergency room when I look at our patient flow. The IOM has been addressing the problems with patient flow since approximately 2006. Everyone benefits from successful patient flow. Nurses are less stressed, patients are happy with quick turnaround times, and the emergency room does not get backed up with patients who need to be admitted. One of the first recommendations was the triage system. Our hospital uses the recommended triage system. We also have a “patient flow nurse” whose primary job is to room patients, take vitals, enter initial assessments, help out fellow nurses with various tasks, and help with discharges. Our physicians have specific time requirements in which they have to lay eyes on the patient, and our hospital has also gone to giving the nurses quite a bit of power with standing orders and protocols. All of this was done to help increase our turnaround times and patient flow.

20. Practice Standard Influence/ Relation to my nursing practice (Erin) • I first learned about the Institute of Medicine (IOM) in nursing school. The IOM became a valuable resource for researching evidence-based information related to various nursing and health related issues. The Robert Wood Johnson Foundation (RWJF) and the IOM worked together in 2008 and developed the report, The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2010) which was a document my nursing class reviewed and referenced frequently. • These practice standards guide my current nursing career. As a new nurse I have extended myself to various nursing experiences and responsibilities in order to utilize the information I gained during my primary nursing education. Secondly I have chosen to achieve a higher level of education and training through Ferris State University in order to advance my degree. I have also taken the responsibility of working together with other health professionals in order to improve upon the current health care system. I am currently a member of the American Nurses Association and active in volunteering my nursing skills to help others in the community. I am outspoken about the importance of providing responsible health care to all individuals and advocate frequently for advancing our current system. Finally, in my personal workplace I am continually looking to improve safety for my patients. I recognize what issues are of the utmost importance and provide my place of employment with evidence-based suggestions to improve care. As such, I continue to utilize the IOM for research and support in my nursing practice.

21. Practice Standard Influence/ Relation to my nursing practice (continued Erin) • In support of the To Err is Human Report the facility that I am employed with has instituted an electronic medication administration system that focuses on the principle of the 6 rights of medication administration. Checking the right person, the right dose, the right time, the right route, right drug, and right documentation is done with the assistance of a computer system that has a requirement to check appropriate boxes noting the rights have been addressed. Often times nurses complain about the system because it takes time away from other tasks, feeling they are just clicking boxes. In reality these nurses are following a program set up for them in order to safeguard not only the patient but the nurses themselves. I support the medication check system.

22. Practice Standard Influence/ Relation to my nursing practice (Katie) • The IOM influences my nursing practice greatly. The biggest way that the IOM affects my practice is through all of the evidence based studies they do. Two of the studies that impact my practice are To Err is Human and the Future of Nursing. • To Err is Human has impacted my nursing practice at my hospital in many ways. Whenever an error occurs with a patient, like a medication error, we are required to fill out what is called a quality control report. These reports are then sent to the manager and then to risk management. The point of the report is not to get people into trouble, but rather to learn how to prevent the error from happening again. • The four key messages set by the IOM’s new report Future of Nursing, impacts my nursing practice and career in a major way. I am already going back to school for my BSN and I am considering continuing on after that. I am also interested in collaborating with multidisciplinary team members to establish new policies and procedures that promote patient safety.

23. References Institute of Medicine charter and bylaws [Charter and Bylaws]. (2006). Retrieved from Institute of Medicine website: http://www.iom.edu/ Institute of Medicine of the National Academies (n.d.). Retrieved November 24, 2012 from http://www.iom.edu/About-IOM.aspx Institute of Medicine of the National Academies. (2012). Presidents Report Supplement. Institute of Medicine of the National Academies. Retrieved November 24, 2012, from http://www.iom.edu/About-IOM/~/media/Files/About%20the%20IOM/President-Supplement-2012.pdf IOM future of nursing report recommendations are in: now what? Implications for nursing. (2011). New Jersey Nurse, 41(3), 10.

24. References MHA Keystone Center for Patient Safety & Quality (n.d.) Retrieved November 26, 2012 from http://www.mhakeystonecenter.org/initiative.htm National Research Council. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press, 2011To Err is Human: A Safer Health System: released 1999, obtained from http://www.iom.edu/Reports/1999/To- Err-is-Human-Building-A-Safer-Health-System.aspx