Transcript 22. 2015 ANCC Accreditation Program Overview - NE-MSD

2015 Accreditation Program
Overview
Kathy Chappell, PhD, RN, FAAN, FNAP
VP, Accreditation Program and Institute for
Credentialing Research
Continuing Nursing Education
What is the ultimate purpose of
continuing nursing education?
Accreditation
What is the value (or is there value) in
using accreditation standards?
Burning question
What is the one thing you want to make
sure I cover before the end of today?
Effective Continuing Education
• Incorporates needs assessments (gap analysis) to ensure that the
activity is controlled by and meets the needs of health professionals;
• Is interactive (e.g., group reflection, opportunities to practice
behaviors);
• Employs ongoing feedback to engage health professionals in the
learning process;
• Uses multiple methods of learning and provide adequate time to
digest and incorporate knowledge; and
• Simulates the clinical setting.
Redesigning Continuing Education in the Health Professions, 2010
Adult Learners
To develop competence, learners must
have:
• A deep foundation of factual learning
• They must understand facts and ideas in the
context of a conceptual framework
• And they must organize knowledge that facilitates
retrieval and application
Bransford and colleagues, 2000
How People Learn
PROFESSIONAL
PRACTICE GAP
Starting out
• Problem in practice or opportunity for
improvement (professional practice gap)
• How do you know it is a problem?
• What data do you have to validate the
problem?
• What is the reason that the problem exists?
Professional Practice Gap
Professional Practice Gap
Gap is the difference between the current state
of “what is” and the desirable or achievable
state “what should be or desired”
Professional practice gap
What is:
35-50% screened
Traditional
continuing
education
What should be:
annual dilated
exams
Typical CE and transfer
Clinical
Practice
Typical
CE
Clinical
Practice
Outcomes-based CE and transfer
Clinical
Practice
Outcomes
Based
CE
Clinical
Practice
Miller’s Model of Clinical Competence
Miller’s
Model of
Clinical
Competence
Knows: learner has knowledge about the topic/subject
Knows how: learner is capable of applying the knowledge
Shows how/does: learner is able to apply knowledge and skills in a
simulated setting (shows how) or the practice environment (does)
Determining the underlying reason for a gap
Gap due to knowledge – doesn’t know
Gap due to skills – doesn’t know how
Gap due to practices – not able to show or
do in practice
Educational Design Process
• Assess knowledge (knows):
• Simple knowledge tests (multiple choice or similar)
• Assess skill (knows how):
• Case studies/extended matching multiple choice
• Case presentations
• Essay questions
• Assess practice (shows/does):
• Simulation (Objective Structured Clinical
Examination)
• Observation in the practice setting
* ACCME uses the analogous terms knowledge, competence and performance
Moore’s Model of CME Outcomes
Traditional CME
17
18
What is an outcome?
• An outcome is the
result of an activity or
program.
• Educational
outcome: the result
of an educational
activity or program.
• What kinds of
educational outcomes
are there?
Planning
• What is the underlying educational need?
• Knowledge, skill, practice, none
• What is the desired learning outcome?
• How will you evaluate change?
Gap analysis worksheet
Let’s practice
Current
state
Desired
state
Identified
gap
Evidence to
validate gap
Gap due to
knowledge, skill
and/or practice
Learning
outcome
New
monitors
have been
purchased
for the ICU
Nurses
know how
to set up
and use
the
monitors
accurately
and safely
Nurses
currently
do not
know how
to use the
new
monitors
The majority
of nurses in
the ICU have
no experience
with the new
monitors; new
technology
Knowledge – have
not had exposure to
new monitor; do
not know basic
features of monitor
system
Nurses will
successfully
demonstrate
knowledge
related to use
of new
monitoring
system
Skill – don’t know
how to use the new
monitor
Practice – have not
used the new
monitor in patient
care
Method of
evaluation
Nurses will pass
post-test with
score of 90% or
greater with
content focused
on safe use of
new monitoring
system.
Let’s practice
Current
state
Pediatric
patients in
respiratory
distress are
placed on a
nonrebreather
facemask
within 5
minutes of
presentation
to the
Emergency
Department
100% of the
time but
frequently the
facemask is
not applied
correctly
Desired
state
Identified
gap
Evidence to
validate gap
Pediatric
patients in
respiratory
distress are
placed on a
nonrebreather
facemask
applied
correctly
within 5
minutes of
presentation
to the
Emergency
Department
100% of the
time
Frequent
inappropriate
nonrebreather
facemask
application for
pediatric
patients in
respiratory
distress
Direct observation
by Clinical Nurse
Specialist;
comments from
respiratory
therapist in ED;
comments from
ED medical staff
Gap due to
knowledge, skill
and/or practice
Lack of skill in correctly
applying facemask to
pediatric patients in
respiratory distress
Learning
outcome
Registered nurses
in the Emergency
Department will
apply a nonrebreather
facemask
correctly to all
pediatric patients
in respiratory
distress
Method of
evaluation
Successful return
demonstration of
application of a nonrebreather facemask
for pediatric patients
in respiratory distress
Let’s practice
Current
state
Desired
state
Identified
gap
40% of
patients 65
and older in
our
community
health clinic
are receiving
the
pneumococc
al vaccine
consistent
with national
guideline
100% of
patients 65
and older in
our
community
health clinic
receive the
pneumococc
al vaccine
consistent
with national
guideline
60% of
patients 65
and older in
our
community
health clinic
are not
receiving the
pneumococc
al vaccine
consistent
with national
guideline
Evidence to
validate gap
Gap due to
knowledge, skill
and/or practice
Chart audit of
Knowledge – unaware
patient files;
of updated guidelines
interviews with
nurses; 75% of
nurses report
they are not
familiar with
updated national
guideline and
therefore were
not providing
information
about the vaccine
Learning
outcome
Registered
nurses will
demonstrate
they know the
updated vaccine
recommendatio
ns for all
patients 65 and
older
Method of
evaluation
Complete post-test
with passing rate of
80% or greater
Other examples
• Nurse Educators
• Knowledge
• Components of high quality evidence
• Skill
• How to evaluate evidence
• Practice
• Using/applying evidence in practice
Other examples
• Nurse Administrators
• Knowledge
• Components of a business case proposal
• Skill
• How to calculate return on investment
• Practice
• Creating, tracking and revising a budget
Think, Pair, Share
 Think: Of a problem in practice or opportunity
for improvement you want to address
 Pair: Find someone you don’t know and
describe the problem or opportunity; define the
professional practice gap
 Share: Switch roles
 Share again: Share with table/group
Clinical Scenario
The incidence of pediatric asthma has significantly increased in the local community over the
past 10 years. Approximately 1 in 5 children between the ages of 5 and 12 in this community
have been diagnosed with asthma. When compared to children without asthma in the same
community, children with asthma are more likely to miss school, are less likely to participate in
extracurricular activities, and consume significantly more health care dollars per child. Parents
of children with asthma are also more likely to miss work when compared to parents of children
without asthma. A recent evaluation of population health conducted by the local health
department demonstrated that significantly more children with asthma were overweight or obese
when compared to children without asthma.
This weekend, one of the patients in your pediatric clinic was admitted to the hospital in severe
respiratory distress. Lab results demonstrate that the child’s serum theophylline levels were not
therapeutic. The mother states that she has been trying to have the child (13 years old) assume
responsibility for her taking her own medications. The child states that she did not like to take
the medication because it made her too jittery and anxious. The child tried to explain this to the
physician during her last appointment, but feels that the physician didn’t listen to her concerns.
She also told the nurse, and the nurse said she would talk it over with the doctor but nothing
changed.
EDUCATIONAL
INTERVENTION
Clinical Scenario
There has been an increase in the number of patients returning to the hospital
within 30 days. More re-admitted patients have a post-surgical diagnosis rather
than a medical diagnosis. The Chief Surgical Officer has evaluated performance
outcomes for surgeons in his department. Patients of two surgeons are
significantly more likely to be readmitted when compared to patients of peers.
When questioned, the two surgeons dispute the trend and both blame
difficulties communicating with the nurses on the surgical floor. The nursing
staff from the surgical floor rate physician-nurse collaboration as poor.
 Of the 10 surgeons admitting patients into the hospital, 6 describe physician-nurse
collaboration as moderate to strong and 4 describe collaboration as fair to poor.
 The nursing staff rates physician-nurse collaboration as fair to poor.
 80% of patients who return to the hospital within 30 days were discharged after 6
pm.
 60% of patients who return to the hospital within 30 days state that they did not
understand their discharge instructions when they left the hospital.
 The nursing staff says when they try to tell a surgeon that a patient is not ready for
discharge, their concerns are rarely acknowledged.
References
• Miller, G. E. (1990). The Assessment of Clinical
Skills/Competence/Performance. Academic Medicine,
65(9), S63 – S67.
• Moore, D. E., Green, J. S. & Gallis, H. A. (2009).
Achieving Desired Results and Improved Outcomes:
Integrating Planning and Assessment Throughout
Learning Activities. Journal of Continuing Education in
the Health Professions, 29(1), 1 – 15.
PLANNING
COMMITTEE
Planning Committee
• Nurse Planner
• Active, unencumbered nursing license
• Prepared at baccalaureate degree or higher
• Responsible for compliance of activity being planned
• Content Expert
• Content expertise in subject matter
• Others as desired
LEARNING OUTCOMES
Learning Outcome
• Eliminated purpose
• Eliminated objectives
• Require learning outcome(s)
• Learning outcome
• Outcomes-based approach
• Learner-centric
• Explicit description of what a learner should know, be able
to apply and/or be able to do as a result of participating in
the educational activity
• Measurable, objective
• Capable of being assessed
Learning Outcome
• Must be based on the desired outcome of the
educational activity
• Need to start with the end in mind
• What do you want learners to know, be able to do,
can do after participating in the educational activity?
• Strategies:
• 5 Whys
• Diagram (fishbone)
Learning Outcome
Learning Objective
Learning Outcome
• List 5 side effects of anti-hypertensive
agents
• Discuss risks associated with untreated
hypertension
• State normal range for blood pressure
Knowledge: Demonstrate knowledge of
evidence-based treatment for
hypertensive patients by passing post-test
with score of ≥ 80%
Competence/Skill: Correctly identify
required actions to manage patients in
hypertensive crisis by analyzing a case
study.
Performance: Utilize an evidence-based
protocol when caring for hypertensive
patients
Learning Outcome
Learning Objective
Learning Outcome
• Describe characteristics of effective
communication styles
• List 5 methods of creating a safe
environment for holding a confidential
conversation
• Define SBAR
• Apply the principles of SBAR when
communicating critical information
Knowledge: At conclusion of the educational
activity, participants will self-report knowledge
gain of effective communication styles using
Likert scale
Competence/Skill: At conclusion of the
educational activity, participants will self-report
intent to change practice by applying evidencebased communication strategies
Performance: At 6 month post-program
evaluation, participants will self-report actual
change in practice
Patient Outcomes: At 9 month post-program
evaluation, participants will self-report impact
on patient outcomes as a result of change in
communication strategies
Learning Outcomes
• Objectives can be written "out of context", but learning
outcomes connect the identified practice gap with the
related educational need
• Learning outcomes frame the context for objectives
• Learning outcomes demonstrate why "list", "discuss",
and "state" are important
• Learning outcomes provide the measurable evidence of
progress in closing the practice gap - objectives don't do
that
PLANNING
Planning
• What content are you going to use within the
activity?
• How are you going to engage learners?
• What criteria are you going to use for successful
completion?
• How are you going to evaluate the activity?
Content: Evidence-based or based on bestavailable evidence
Resources:
• Planning document has categories for choosing evidence
• http://www.nursingworld.org/Research-Toolkit
Evidence continued
•
Peer-reviewed journals or peer-reviewed textbooks ensures that the
article or content has been critically evaluated by experts in the field.
•
Web-based resources that require peer review or only allow content
that has been peer-reviewed ensures that readers have access to highquality evidence. Organizations such as the Agency for Healthcare
Research and Quality (AHRQ), National Quality Forum (NQF), or Centers
for Disease Control (CDC) regularly post evidence related to particular
diseases or treatment of disease.
•
Evidence-based clinical guidelines are posted on sites such as
www.guidelines.gov.
•
Content for educational activities should also be chosen from resources that
have been recently published. One guideline is to look for articles that have
been published within the past 5 – 7 years, or as appropriate for the
content area.
Engaging Learners
• Strategies to engage learners may include but are not
limited to:
•
•
•
•
Integrating opportunities for dialogue or question/answer
Including time for self-check or reflection
Analyzing case studies
Providing opportunities for problem-based learning
• Active learner engagement may function as an
opportunity for formative assessment during the
educational activity by providing the presenter with
immediate learner feedback.
Criteria for Successful Completion
• Criteria may include but are not limited to:
• Awarding credit commensurate with participation in the activity
• Requiring attendance for a specified period of time (e.g., 100%
of activity, or miss no more than 10 minutes of activity)
• Successfully completing a post-test (e.g., attendee must score
X% or higher)
• Completing an evaluation form
• Successfully completing a return demonstration
• Criteria should be based on the desired learning
outcome
Evaluation
Evaluation Options
Short-Term






Intent to change practice
Active participation in learning
activity
Post-test
Return demonstration
Case study analysis
Role-play
Long-Term




Self- reported change in
practice
Change in quality outcome
measure
Return on Investment (ROI)
Observation of performance
Planning
• Awarding contact hours
• Live
• Enduring
• Blended
• 60 minute hour
• Method must be defensible
• Mergener’s formula
Identifying and Resolving COI
• Identifying and resolving any conflicts of
interest
• All individuals in a position to control content
• Disclose all relationships with commercial interest
organizations or relevant relationships with
commercial interest organizations
• Within past 12 months
• To include relationships of spouse/significant other
http://www.nursecredentialing.org/Accreditation-CEContentIntegrity.pdf
Eligibility to participate in planning/presenting
• Employees of commercial interest organizations are not permitted
to serve as planners, speakers, presenters, authors and/or content
reviewers if the content of the educational activity is related to the
products or services of the commercial interest organization.
• Employees of commercial interest organizations are permitted to
serve as planners, speakers, presenters, authors and/or content
reviewers if the content of the educational activity is NOT related to
the products of the commercial interest organization.
• Individuals who have non-employee relationships with commercial
interest organizations (see bullet 2 below) are permitted to serve as
planners, speakers, presenters, authors and/or content reviewers as
long as the Provider has implemented a mechanism to identify,
resolve and disclose the relationship as outlined in these standards.
Conflict of Interest
The potential for conflict of interest exists when an
individual has the ability to control or influence the
content of an educational activity and has a
financial relationship with a commercial interest,*
the products or services of which are relevant to
the content of the educational activity.
Commercial Interest Organization
The American Nurses Credentialing Center (ANCC) defines
an organization as having a commercial interest
(“Commercial Interest Organization”)* if it:
• Produces, markets, sells or distributes health care goods or
services consumed by or used on patients;
• Is owned or operated, in whole or in part, by an organization that
produces, markets, sells or distributes health care goods or
services consumed by or used on patients; or
• Advocates for use of the products or services of commercial
interest organizations.
Relevant Relationships
Relevant relationships, as defined by ANCC, are
relationships with a commercial interest if the products
or services of the commercial interest are related to
the content of the educational activity.
• Relationships with any commercial interest of the
individual’s spouse/partner may be relevant
relationships and must be reported, evaluated, and
resolved.
• Relationships are considered relevant if they have
occurred within the past 12 months
Resolution Process – may include but not
limited to…
•
Removing the individual with conflict of interest from participating in all parts of the educational
activity.
•
Revising the role of the individual with conflict of interest so that the relationship is no longer
relevant to the educational activity.
•
Not awarding continuing education contact hours for a portion or all of the educational activity.
•
Undertaking review of the educational activity by the Nurse Planner to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity and absence of bias
AND monitoring the educational activity to evaluate for commercial bias in the presentation.
•
Undertaking review of the educational activity by the Nurse Planner to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity and absence of bias
AND reviewing participant feedback to evaluate for commercial bias in the activity
•
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity and absence of bias
AND monitoring the educational activity to evaluate for commercial bias in the presentation.
•
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity and absence of bias
AND reviewing participant feedback to evaluate for commercial bias in the activity
Decision Matrix
1. Identify who has the opportunity to influence the
content of the educational activity.
2. For all individuals who have the opportunity to influence
content: document relationships the individual
(including spouse/significant other) has with
commercial interest organizations within the past 12
months.
3. Evaluate relationships individuals have with commercial
interest organizations.
4. Are the products or services of the commercial interest
relevant to content of educational activity?
5. If relationship is relevant, resolution is required
Scenarios – COI or not?
a. Jane Smith is being considered to serve as a content expert on your planning
committee. She is also on the speaker’s bureau with a commercial entity, which
produces drugs for diabetes. The conference is about the latest research in diabetes
management.
b. Lisa Taylor is being considered to serve as a content expert on your planning
committee. Her husband is vice president of a company that produces pacemakers.
The topic for the conference is horizontal violence.
c. Jack Williams is a sales representative with a pharmaceutical entity and is being
considered to serve on your planning committee.
d. The keynote speaker is an expert in the topic of women’s health and has written a
best-selling book on the topic. The conference is about implementing the latest
research findings on women’s health.
e. The author of a web-based learning activity on special considerations for people with
arthritis has declared no conflict of interest on his biographical data form. When his
assistant sends you a copy of the author’s publicity statement, you discover he wrote
multiple books on arthritis and produced a topical ointment for patients with arthritis.
Commercial Support
commercial support. Financial or in-kind
contributions given by a commercial interest that
are used to pay for all or part of the costs of a CNE
activity. Providers of commercial support may not
be providers or joint providers of an educational
activity.
Commercial support
• What if the representative of the proposed commercial interest
organization refuses to sign the commercial support agreement?
• What if a commercial interest organization stipulates that, in order to
receive funds, advanced practice nurses must be in the target
audience for the session?
• A commercial interest organization wants to give learners note pads
featuring the commercial entity’s logo. What is the Accredited
Provider’s responsibility?
• The sales representative from the commercial interest organization
providing support for the Accredited Provider’s conference wants to
attend conference sessions. Is this permissible?
Commercial Support
•
A commercial interest organization providing commercial support wants to
use her/his company’s written agreement rather than the Accredited
Provider’s. Is that acceptable?
•
A commercial interest organization providing commercial support wants to
include a full-page advertisement on the inside cover of the course syllabus.
What is permissible?
•
Can a commercial interest organization provide food for a “lunch and learn”
planned by the Accredited Provider?
•
I’m the Nurse Planner working on a learning activity for which a commercial
interest organization gave $5000 to support the event. Do I need to keep a
record of how this money is spent?
•
May the Accredited Provider include the logo of a commercial interest
organization on its marketing material?
Decision Matrix
Financial or in-kind support for the activity:
• Yes or No?
• If yes, classify the organization providing the support:
commercial interest or not?
• If commercial interest = commercial support
• If not, no requirement to document
Exhibitors, Vendors, Advertising
• Revenue attained from exhibitor, vendor or
advertising is not considered commercial
support.
• Commercial support is relevant when the money
is directly tied to an educational activity awarding
ANCC contact hours
Joint Providership
• Two organizations working together to plan, implement
and evaluate an educational activity
• One is provider, one is joint provider
• Joint provider may not be a commercial interest
organization
• Provider awards contact hours
• Marketing materials must reflect the provider awarding
contact hours
• Learners must be informed of joint providership
Educational Design Process
• Achieving the outcome
• Using summative data
• Measuring a change in nursing practice or Nursing
Professional Development
•
•
•
•
•
Go back to the outcome of the activity
What did you want to achieve?
Did you close the gap?
Why or why not?
What next?
Recordkeeping
•
Professional Practice gap
•
•
•
•
•
•
•
•
•
•
•
Evidence to validate gap
•
Educational need that underlies gap
Description of target audience
•
Desired learning outcome(s)
Description of content with references or •
resources
•
Learner engagement strategies
Criteria for awarding contact hours
Description of evaluation method
•
•
Current state
Desired state
•
Evidence that change in knowledge, skills
and/or practices was assessed
Nurse Planner
Content Expert
•
•
Method of calculation
Certificate of completion
Commercial support agreement if
applicable
Required information to learners:
•
•
•
•
•
•
Names and credentials of all individuals
in a position to control content
•
•
COI documentation for all individuals in
a position to control content
Evidence of resolution process if
applicable
Number of contact hours awarded
Accreditation statement
Criteria for awarding contact hours
Presence or absence of COI for all
individuals in a position to control content
Commercial support if applicable
Expiration date if applicable
Joint providership if applicable
Summative evaluation
Return on Investment
• Not an accreditation criteria requirement!
• Think about the return on investment for
educational activities
•
•
•
•
NOT the “smiley scale”
Cost reduction
Efficiency
Effectiveness
Questions?
Contact Northeast MSD
[email protected]
1-888-373-1291